Carotid endarterectomy: The change in practice over 11years in a stroke centre

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. Methods: All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome. Results: There were 510 CEAs performed during 2004-2014 and 95 CASs during 2003-2008. The proportion of patients undergoing CEA compared to CAS increased from 60% to 90% from 2004 to 2008 (P<0.001). CAS patients were more likely to have cardiac co-morbidities. From 2004 to 2014, the proportion of CEA patients aged ≥80years increased (P=0.001) and the proportion of asymptomatic patients decreased (P=0.003) over time. Median time from symptom onset to surgery decreased from 52days (Q1: 25, Q3: 74) in 2004 to 8days (Q1: 5, Q3: 37) in 2014 (P<0.001). Use of preoperative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (P<0.001). Overall, 5.9% of CEAs were complicated by death, stroke or acute myocardial infarction with no significant change over time. Conclusion: The trends in CEA practice at our centre align with international trends and guidelines. This study provides a representative indicator of Australian hospital practice, and illustrates how evidence from research is translated into clinical care.

Original languageEnglish
Pages (from-to)314-319
Number of pages6
JournalANZ Journal of Surgery
Volume89
Issue number4
DOIs
Publication statusPublished - 1 Apr 2019

Keywords

  • Carotid endarterectomy
  • Carotid stenosis
  • Stroke
  • Trends

Cite this

@article{e7cbaf4b913048359f9fac8518f4db66,
title = "Carotid endarterectomy: The change in practice over 11years in a stroke centre",
abstract = "Background: Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. Methods: All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome. Results: There were 510 CEAs performed during 2004-2014 and 95 CASs during 2003-2008. The proportion of patients undergoing CEA compared to CAS increased from 60{\%} to 90{\%} from 2004 to 2008 (P<0.001). CAS patients were more likely to have cardiac co-morbidities. From 2004 to 2014, the proportion of CEA patients aged ≥80years increased (P=0.001) and the proportion of asymptomatic patients decreased (P=0.003) over time. Median time from symptom onset to surgery decreased from 52days (Q1: 25, Q3: 74) in 2004 to 8days (Q1: 5, Q3: 37) in 2014 (P<0.001). Use of preoperative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (P<0.001). Overall, 5.9{\%} of CEAs were complicated by death, stroke or acute myocardial infarction with no significant change over time. Conclusion: The trends in CEA practice at our centre align with international trends and guidelines. This study provides a representative indicator of Australian hospital practice, and illustrates how evidence from research is translated into clinical care.",
keywords = "Carotid endarterectomy, Carotid stenosis, Stroke, Trends",
author = "Tse, {Gabrielle T.W.} and Kilkenny, {Monique F.} and Chris Bladin and Michael Grigg and Dewey, {Helen M.}",
year = "2019",
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Carotid endarterectomy : The change in practice over 11years in a stroke centre. / Tse, Gabrielle T.W.; Kilkenny, Monique F.; Bladin, Chris; Grigg, Michael; Dewey, Helen M.

In: ANZ Journal of Surgery, Vol. 89, No. 4, 01.04.2019, p. 314-319.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Carotid endarterectomy

T2 - The change in practice over 11years in a stroke centre

AU - Tse, Gabrielle T.W.

AU - Kilkenny, Monique F.

AU - Bladin, Chris

AU - Grigg, Michael

AU - Dewey, Helen M.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. Methods: All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome. Results: There were 510 CEAs performed during 2004-2014 and 95 CASs during 2003-2008. The proportion of patients undergoing CEA compared to CAS increased from 60% to 90% from 2004 to 2008 (P<0.001). CAS patients were more likely to have cardiac co-morbidities. From 2004 to 2014, the proportion of CEA patients aged ≥80years increased (P=0.001) and the proportion of asymptomatic patients decreased (P=0.003) over time. Median time from symptom onset to surgery decreased from 52days (Q1: 25, Q3: 74) in 2004 to 8days (Q1: 5, Q3: 37) in 2014 (P<0.001). Use of preoperative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (P<0.001). Overall, 5.9% of CEAs were complicated by death, stroke or acute myocardial infarction with no significant change over time. Conclusion: The trends in CEA practice at our centre align with international trends and guidelines. This study provides a representative indicator of Australian hospital practice, and illustrates how evidence from research is translated into clinical care.

AB - Background: Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. Methods: All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome. Results: There were 510 CEAs performed during 2004-2014 and 95 CASs during 2003-2008. The proportion of patients undergoing CEA compared to CAS increased from 60% to 90% from 2004 to 2008 (P<0.001). CAS patients were more likely to have cardiac co-morbidities. From 2004 to 2014, the proportion of CEA patients aged ≥80years increased (P=0.001) and the proportion of asymptomatic patients decreased (P=0.003) over time. Median time from symptom onset to surgery decreased from 52days (Q1: 25, Q3: 74) in 2004 to 8days (Q1: 5, Q3: 37) in 2014 (P<0.001). Use of preoperative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (P<0.001). Overall, 5.9% of CEAs were complicated by death, stroke or acute myocardial infarction with no significant change over time. Conclusion: The trends in CEA practice at our centre align with international trends and guidelines. This study provides a representative indicator of Australian hospital practice, and illustrates how evidence from research is translated into clinical care.

KW - Carotid endarterectomy

KW - Carotid stenosis

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DO - 10.1111/ans.14241

M3 - Article

VL - 89

SP - 314

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JO - ANZ Journal of Surgery

JF - ANZ Journal of Surgery

SN - 1445-1433

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