Imaging findings and referral outcomes of rapid assessment stroke clinics.
OBJECTIVE
A rapid assessment stroke clinic (RASC) was established to provide a rapid diagnostic service to individuals with suspected transient cerebral or ocular ischaemia or recovered non-hospitalized strokes. In this report we review imaging findings and clinical outcomes of patients proceeding to the carotid surgery programme.


METHODS
Between October 2000 and December 2002, 1339 people attended the RASC. The findings of head CT and carotid Doppler ultrasound of the 1320 patients who underwent brain and carotid imaging were reviewed, and the number subsequently proceeding to carotid angiography and intervention was reported.


RESULTS
CT head scans were normal in 57% of cases; 38% demonstrated ischaemia or infarction; and 3% yielded incidental or other significant findings not related to ischaemia. On screening with carotid Doppler ultrasound, 7.5% showed greater than 50% stenosis on the symptomatic side. A total of 83 patients (6.2%) proceeded to cerebral angiography and 65 (4.8%) underwent carotid endarterectomy or endovascular repair.


CONCLUSIONS
Rapid-access neurovascular clinics are efficient in selecting patients for carotid intervention, but this is at a cost and the number of potential strokes prevented is small. Alternative management pathways based on immediate medical treatment need to be evaluated.
Widjaja
E
E
Radiology Department, Royal Hallamshire Hospital, Sheffield, UK. elysa.widjaja@sth.nhs.uk
Manuel
D
D
Hodgson
T J
TJ
Connolly
D J A
DJ
Coley
S C
SC
Romanowski
C A J
CA
Gaines
P
P
Cleveland
T
T
Thomas
S
S
Griffiths
P D
PD
Doyle
C
C
Venables
G S
GS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography