First year of a fast track carotid duplex service

The risk of major stroke is highest in the first three months after a transient ischaemic attack (TIA). Urgent carotid endarterectomy can reduce the risk in patients with a severe carotid stenosis. An express carotid duplex service has been established and this study analyses the effect in the first year.

Local GPs were offered a new service whereby a carotid duplex scan would be guaranteed within 14 days of referral of any patient who had a recent clearly documented TIA or amaurosis fugax. Referral letters were faxed directly to the Vascular Office where the duplex scan was authorised by a consultant vascular surgeon. Patients with significant carotid disease on duplex were assessed in the out-patient clinic in preparation for surgery.

In the first 12 months of the service, 90 fast track duplex scans were performed. In the same interval 490 routine carotid duplex scans were carried out. Some 13 carotid endarterectomies were carried out on patients from the fast track group (13/90, 14%), with a median delay between referral and surgery of 30 days (range 20-45) and median duration between onset of symptoms and surgery of 51 days (range 27-406). In the non fast track group 14/490 (2.8%) scans resulted in carotid intervention, a median 127 days (range 64-184) after referral.

The fast track service significantly reduced the delay between referral and surgery. Timing of carotid surgery is critical. Performing the surgery at the time of greatest risk increases the benefit of carotid endarterectomy. Urgent and appropriate referral from the GPs is vital for the service to run effectively.