Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.
Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman.
Sultan Qaboos Univ Med J. 2022 Nov;22(4):561-565. doi: 10.18295/squmj.4.2022.028. Epub 2022 Nov 7.
Stroke is the second leading cause of death worldwide, resulting in 5.5 million deaths in 2016. Vascular interventions, including carotid endarterectomy (CEA) and carotid artery stenting, play a major role in stroke prevention, especially when performed early after onset of symptoms. This study aimed to define the role of vascular surgeons in ischaemic stroke management and hence improve referral patterns by creating an algorithm for the referral process. This could reduce time to intervention and optimise patient benefit from intervention.
This retrospective study reviewed symptomatic and asymptomatic patients with atherosclerotic disease of the carotid artery who were referred to the Vascular Surgery Unit of Sultan Qaboos University Hospital, Muscat, Oman, from April 2018 to March 2020 to examine factors influencing recognition of suitable candidates for intervention. Following analysis of the data, algorithms/protocols were created to simplify the referral process of symptomatic and asymptomatic carotid artery disease for surgical intervention.
A total of 38 patients with ischaemic stroke were recognised as having carotid artery stenosis and were referred to the vascular surgery service during the study period. Only six met the criteria for CEA, four of which underwent the procedure.
Choice of patients for CEA involves multiple steps, with potential for missed opportunities. By involving a multidisciplinary team approach, the recommended protocol aims to lead to early and appropriate referral to a vascular surgeon or an interventional radiologist, resulting in increased and optimised intervention in stroke prevention.
中风是全球第二大致死原因，2016 年导致 550 万人死亡。血管介入治疗，包括颈动脉内膜切除术（CEA）和颈动脉支架置入术，在预防中风方面发挥着重要作用，尤其是在症状发作后早期进行。本研究旨在确定血管外科医生在缺血性中风管理中的作用，并通过创建一种转诊流程算法来改善转诊模式。这可以减少干预时间，并优化患者从干预中获益。
这项回顾性研究对 2018 年 4 月至 2020 年 3 月期间被转诊到阿曼马斯喀特苏丹卡布斯大学医院血管外科的有症状和无症状的颈动脉粥样硬化患者进行了回顾，以检查影响识别适合干预的候选者的因素。在对数据进行分析后，创建了算法/方案来简化有症状和无症状颈动脉疾病的手术干预转诊流程。
在研究期间，共有 38 名缺血性中风患者被识别为患有颈动脉狭窄，并被转诊到血管外科服务。仅有 6 名符合 CEA 标准，其中 4 名接受了该手术。
CEA 的患者选择涉及多个步骤，可能会错失机会。通过采用多学科团队方法，推荐的方案旨在尽早并适当地将患者转介给血管外科医生或介入放射科医生，从而增加并优化中风预防的干预。
