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Carotid endarterectomy in the UK: acceptable risks but unacceptable delays
D Dellagrammaticas1, S Lewis, B Colam
1Leeds Vascular Institute, The General Infirmary at Leeds.
Insights
Carotid endarterectomy (CEA) benefits stroke prevention for severe carotid stenosis. However, current UK delays to surgery are excessive, potentially reducing CEA
Area of Science:
- Vascular Surgery
- Neurology
- Clinical Trials
Background:
- Carotid endarterectomy (CEA) is a crucial intervention for preventing stroke in patients with severe carotid stenosis.
- The efficacy of CEA is contingent upon achieving acceptably low surgical morbidity and mortality rates.
Purpose of the Study:
- To evaluate the contemporary performance and outcomes of CEA in the United Kingdom.
- To analyze the time delay between symptomatic events and surgical intervention in CEA patients.
Main Methods:
- An interim analysis of 30-day postoperative outcomes from 1,001 patients in the GALA Trial (UK).
- Data were collected from a multicenter randomized trial comparing general versus local anesthesia for CEA.
- The time from the last symptomatic event to surgery was recorded.
Main Results:
- The 30-day risks were: stroke 5.3%, myocardial infarction (MI) 0.4%, death 1.7%, and composite stroke, MI, or death 6.4%.
- The median delay between symptom onset and surgery was 82 days.
- These outcome risks are comparable to those reported in major CEA randomized trials.
Conclusions:
- Current delays to carotid endarterectomy surgery in the UK are excessive.
- These substantial delays likely diminish the overall benefit of CEA for stroke prevention.
Abstract:
Carotid endarterectomy (CEA) is of benefit for stroke prevention in the presence of severe carotid stenosis, provided surgical morbidity and mortality are acceptably low. To assess the current performance of CEA in the UK, an interim analysis of 30-day postoperative outcome data, blinded to anaesthetic allocation, from the first 1,001 UK patients randomised in the GALA Trial (multicentre randomised trial of general versus local anaesthesia for CEA) took place and the time from last symptomatic event to surgery was recorded. The 30-day risk of stroke was 5.3%, myocardial infarction (MI) 0.4%, death 1.7%, and stroke, MI or death 6.4%. Median delay between symptoms and surgery was 82 days. These risks are similar to those reported in the large randomised trials of CEA, but current delays to surgery are excessive and must have substantially reduced the benefit of endarterectomy.