[Carotid endarterectomy. Experiences with shortening of interval between symptom and operation].
BACKGROUND
Carotid endarterectomy (CEA) prevents transient ischemic attack and stroke in patients with symptomatic high-grade carotid stenosis. In 2004 Rothwell et al showed that maximal benefit is gained if CEA is performed less than three weeks after the onset of the symptom. With the aim of observing this recommendation, in 2005 the Department of Vascular Surgery, Gentofte Hospital, introduced an accelerated course of examinations, a fast track, prior to CEA.


METHODS
A retrospective study of the course of all patients operated with CEA during the period from June 2003 through September 2006.


RESULTS
A total of 147 CEAs were performed on 145 patients, 51 before and 96 after the introduction of fast track. The period between the first symptom and CEA was reduced after the introduction of fast track to 31 days. It was easiest to reduce the time up to CEA in our own department and in the neurological departments. The stroke and death rate was unchanged, 4% and 3% before and after fast track respectively.


CONCLUSIONS
The time between symptom and CEA can be shortened by means of a fast track after thorough information and reorganization of the work involving these patients. In order to bring the length of the period below the recommended three weeks, initiatives must be taken especially among specialist outside hospitals and among departments of general internal medicine.
Rathenborg
Lisbet Knudsen
LK
Gentofte Hospital, Karkirurgisk Afdeling B, Hellerup. likn@geh.regionh.dk
Baekgaard
Niels
N
Jensen
Leif Panduro
LP
D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006801:Humans; D012017:Referral and Consultation; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control; D013997:Time Factors