title: [From CVA or TIA to carotid surgery: the clinical treatment course for patients with symptomatic carotid disease could be shorter].
abstract: OBJECTIVE
  To gain insight into the duration and the various components of the clinical treatment course for patients with symptomatic carotid artery stenosis, in order to improve the care provided to these patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All patients who had undergone a carotid intervention for significant symptomatic carotid stenosis from 2001 to 2011 were included. Quantile regression analysis was used to assess the changes which had occurred in the median duration of the period from neurological event to intervention from 2001 onward. In order to chart the clinical treatment course, it was split up in different components. In addition, the impact of the referrer and the relationship between the time of the intervention and the risk of perioperative complications were also evaluated.
  
  
  RESULTS
  The median duration of the entire clinical treatment course decreased during the study period from 79 days (interquartile range (IQR): 59-113) in the reference period 2001-2004 to 19 days (IQR: 13-28) in 2011. All components of the clinical pathway had contributed to this decline. The duration of the clinical course in patients who had been externally referred was more than 3 times longer (median 67 vs. 21 days, p < 0.01). The total duration of the process did not affect the number of perioperative complications.
  
  
  CONCLUSIONS
  In the last decennium, the duration of the clinical treatment course of care in patients with symptomatic carotid artery disease was greatly reduced. Analyses of the processes which make up the chain of events, however, reveal that there is still much to be gained in the period before initial presentation at the hospital for patients who are referred by their general practitioners as well as those referred by other hospitals.
authors.affiliation: Medisch Spectrum Twente, afd. Vaatchirurgie, Enschede, the Netherlands. j.kolkert@mst.nl
authors.forename: Joé  L P
authors.initials: JL
authors.lastname: Kolkert
authors.forename: Rolf H H
authors.initials: RH
authors.lastname: Groenwold
authors.forename: Juliette T M
authors.initials: JT
authors.lastname: Blauw
authors.forename: Robbert
authors.initials: R
authors.lastname: Meerwaldt
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: R H
authors.initials: RH
authors.lastname: Geelkerken
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery*; D008297:Male; D011314:Preventive Health Services; D012017:Referral and Consultation; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery*; D013997:Time Factors; D014850:Waiting Lists