title: Decreasing the delay to carotid endarterectomy in symptomatic patients with carotid stenosis--outcome of an intervention.
abstract: OBJECTIVE
  Surgical treatment of carotid stenosis after the onset of ischaemic symptoms should be performed within 2 weeks. This aim was accomplished only in 11% during the years 2007-2008 in the Helsinki University Central Hospital (HUCH) region. Since then, special efforts have been made in order to shorten the delay. The aim of this study was to find out how these changes affected the symptom-to-knife time (SKT).
  
  
  METHODS
  All symptomatic patients (n = 144) who had carotid endarterectomy (CEA, n = 145) in HUCH in 2010 were retrospectively analysed and the SKT was determined.
  
  
  RESULTS
  Of the operations, 37% (n = 53) were performed within the recommended 2 weeks. The median SKT was 19 days (1-183). Of the patients who came to HUCH on an emergency basis (n = 80), 55% (n = 45) were operated within 2 weeks and their median SKT was 13 days (1-148).
  
  
  CONCLUSIONS
  The changes that were made in 2008-2009 have significantly shortened the delay in the treatment of carotid stenosis, but the desired time frame of 2 weeks was reached far too seldom. The greatest benefit from preventive CEA is achieved when patients are referred emergently to a clinic where neurologist, imaging resources and vascular surgeon are available.
authors: Department of Vascular Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland. katariina.noronen@hus.fi
authors: K
authors: K
authors: Noronen
authors: P
authors: P
authors: Vikatmaa
authors: T
authors: T
authors: Sairanen
authors: M
authors: M
authors: Lepäntalo
authors: M
authors: M
authors: Venermo
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D016009:Chi-Square Distribution; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists