title: Reducing delay of carotid endarterectomy in acute ischemic stroke patients: a nationwide initiative.
abstract: OBJECTIVE
  Guidelines recommend carotid endarterectomy (CEA) within 2 weeks from an ischemic event. However, previous studies have shown that only a minority of patients undergo CEA within this period. The aim of this study was to examine the effect of a multidisciplinary nationwide initiative aimed at reducing time to CEA after acute ischemic stroke.
  
  
  METHODS
  We examined a historic population-based observational cohort based on individual patient-level records from the Danish Stroke Registry and the Danish Vascular Registry. The implementation of early ultrasound examination of the carotids (within 4 days from admission) in medical departments coupled with fast CEA after referral to a department of vascular surgery were monitored and audited systematically from 2008 and onward.
  
  
  RESULTS
  A total of 813 acute ischemic stroke patients underwent CEA during 2007-2010. The percentage of patients undergoing CEA within 2 weeks increased from 13% in 2007 to 47% in 2010 (adjusted odds ratio, 5.8 [95% CI, 3.4-10.1]). The overall median time decreased from 31 days to 16 days. The percentage of relevant acute ischemic stroke patients receiving early ultrasound examination of the carotids increased from 41% in 2008 to 72% in 2010. The time from referral to operation at a vascular department was reduced by ≈40%.
  
  
  CONCLUSIONS
  Establishing time limits of 4 days to ultrasound examination of the carotids and of 2 weeks to CEA from onset of stroke followed by a systematic multidisciplinary monitoring and auditing of processes was associated with a substantial increase in the proportion of acute ischemic stroke patients who undergo CEA within 2 weeks in Denmark.
authors: Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. agnes_witt@dadlnet.dk
authors: Agnes Hauschultz
authors: AH
authors: Witt
authors: Soren Paaske
authors: SP
authors: Johnsen
authors: Leif Panduro
authors: LP
authors: Jensen
authors: Allan Kornmaaler
authors: AK
authors: Hansen
authors: Heidi Holmager
authors: HH
authors: Hundborg
authors: Grethe
authors: G
authors: Andersen
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D003718:Denmark; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography