Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
Eur J Vasc Endovasc Surg. 2014 Mar;47(3):233-9. doi: 10.1016/j.ejvs.2013.12.013. Epub 2014 Jan 17.
In patients with recently symptomatic carotid artery stenosis, guidelines recommend carotid revascularization within 2 weeks of the index event. The "index event" may be defined as either the first or the most recent event. The delay between the index event and carotid endarterectomy (CEA) over a period of 6 years in a single centre was evaluated and the effect of defining the index event as either the first or the most recent event was assessed.
Observational study.
555 consecutive patients with symptomatic carotid stenosis ≥ 50% treated with CEA between 2007 and 2012 were assessed. In 2010, changes to the in-hospital process of care to reduce delays in referral and CEA were introduced. These changes included, for example, improving access to physicians, imaging, and operating rooms. The delay from symptoms to surgery was expressed in days.
The median time between the first event and surgery was reduced from 53 days (interquartile range [IQR] 30-78) in 2007 to 21 days (IQR 12-45) in 2012, and between the most recent event and CEA from 45 days (IQR 28-67) to 17 days (IQR 9-28). Patients referred directly by their general practitioner more often underwent CEA within 2 weeks than patients referred by specialists from other hospitals. Compared to patients with transient ischaemic attack or ocular symptoms, patients with ischaemic stroke more often underwent CEA within 2 weeks.
A small change in the process of care significantly reduced the delay from the index event to CEA, but in 2012 it still exceeded 14 days in the majority of patients. The definition of the "index event" has a large impact on the total duration of delay, and should therefore be uniform across studies.
对于近期出现症状的颈动脉狭窄患者，指南建议在指数事件发生后 2 周内进行颈动脉血运重建。“指数事件”可定义为首次事件或最近一次事件。评估了在单个中心，从指数事件到颈动脉内膜切除术（CEA）的延迟时间在 6 年内的变化，并评估了将指数事件定义为首次事件或最近一次事件的效果。
观察性研究。
评估了 2007 年至 2012 年间接受 CEA 治疗的 555 例症状性颈动脉狭窄≥50%的连续患者。2010 年，对住院期间的治疗过程进行了更改，以减少转介和 CEA 的延迟。这些变化包括改善医生、影像学和手术室的就诊机会等。手术与症状之间的延迟时间以天表示。
首次事件与手术之间的中位数时间从 2007 年的 53 天（四分位距[IQR]30-78）减少到 2012 年的 21 天（IQR12-45），最近一次事件与 CEA 之间的中位数时间从 45 天（IQR28-67）减少到 17 天（IQR9-28）。直接由全科医生转介的患者比由其他医院专科医生转介的患者更常在 2 周内接受 CEA。与短暂性脑缺血发作或眼部症状患者相比，缺血性脑卒中患者更常在 2 周内接受 CEA。
治疗过程中的一个小变化显著缩短了从指数事件到 CEA 的延迟时间，但在 2012 年，大多数患者仍超过 14 天。“指数事件”的定义对总延迟时间有很大影响，因此应在研究中保持一致。
