title: Rapid access carotid endarterectomy: winning the RACE following a natural disaster.
abstract: OBJECTIVE
  Rapid access carotid endarterectomy (RACE) is the gold standard for stroke prevention in symptomatic patients with 50-99% internal carotid artery stenosis. Diagnosis and referral of eligible patients may be delayed by disruption to local health services. The aim of this study was to evaluate whether service provision was maintained at an appropriate standard (<2 weeks) following a natural disaster.
  
  
  METHODS
  Consecutive symptomatic patients who underwent carotid endarterectomy (CEA) at a tertiary hospital between January 2006 and December 2014 were identified. The timeline from initial presentation to carotid imaging, vascular review and surgery was mapped. The post-earthquake period was defined between 22nd of February 2011 until July 2012.
  
  
  RESULTS
  Of the 404 patients that underwent CEA during the above period, 62 patients presented during the post-earthquake period and these patients comprised the primary study group. The median time between presentation and CEA was nine days. In all, 47 patients had CEA within two weeks from the index event. The number of CEA procedures doubled since 2009.
  
  
  CONCLUSIONS
  Despite many challenges following a major natural disaster, delivery of RACE has been maintained at an acceptable standard. Some delays persist and these remain areas for improvement in future.
authors.affiliation: Department of Surgery, University of Otago, Christchurch.
authors.forename: Manar
authors.initials: M
authors.lastname: Khashram
authors.affiliation: Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch.
authors.forename: Rachel
authors.initials: R
authors.lastname: Falconer
authors.affiliation: Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch.
authors.forename: Afif
authors.initials: A
authors.lastname: Mahmud
authors.affiliation: Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch.
authors.forename: Adib
authors.initials: A
authors.lastname: Khanafer
authors.affiliation: Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch.
authors.forename: Peter
authors.initials: P
authors.lastname: Laws
authors.affiliation: Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch.
authors.forename: Tim
authors.initials: T
authors.lastname: Beresford
authors.affiliation: Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch.
authors.forename: Justin
authors.initials: J
authors.lastname: Roake
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D003695:Delivery of Health Care; D004190:Disasters; D055866:Earthquakes; D016894:Endarterectomy, Carotid / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D062606:Tertiary Care Centers; D016896:Treatment Outcome