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Updated: Jul 8, 2026
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
[Carotid endarterectomy. Experiences with shortening of interval between symptom and operation]
Lisbet Knudsen Rathenborg1, Niels Baekgaard, Leif Panduro Jensen
1Gentofte Hospital, Karkirurgisk Afdeling B, Hellerup. likn@geh.regionh.dk
Insights
Implementing a fast track significantly reduced the time to carotid endarterectomy (CEA) after stroke symptoms. This accelerated pathway improved patient care without increasing stroke or death rates.
Area of Science:
- Vascular Surgery
- Neurology
- Public Health
Context:
- Carotid endarterectomy (CEA) is crucial for preventing stroke in patients with symptomatic high-grade carotid stenosis.
- Evidence suggests optimal benefit from CEA within three weeks of symptom onset.
- A fast-track protocol was implemented to expedite CEA procedures.
Purpose:
- To evaluate the effectiveness of a fast-track system in reducing the time between symptom onset and CEA.
- To assess the impact of the fast-track system on stroke and mortality rates.
Summary:
- A retrospective study analyzed 147 CEAs performed between June 2003 and September 2006.
- Following the fast-track implementation in 2005, the average time from symptom to CEA decreased from 51 days to 31 days.
- Stroke and death rates remained stable at 4% and 3% before and after the fast-track introduction.
Impact:
- The fast-track approach successfully shortened the time to CEA, aligning with clinical recommendations.
- Further optimization requires enhanced collaboration with external specialists and internal medicine departments.
- Improved patient management pathways can lead to better outcomes for stroke prevention.
Introduction:
Carotid endarterectomy (CEA) prevents transient ischemic attack and stroke in patients with symptomatic high-grade carotid stenosis. In 2004 Rothwell et al showed that maximal benefit is gained if CEA is performed less than three weeks after the onset of the symptom. With the aim of observing this recommendation, in 2005 the Department of Vascular Surgery, Gentofte Hospital, introduced an accelerated course of examinations, a fast track, prior to CEA.
Materials And Methods:
A retrospective study of the course of all patients operated with CEA during the period from June 2003 through September 2006.
Results:
A total of 147 CEAs were performed on 145 patients, 51 before and 96 after the introduction of fast track. The period between the first symptom and CEA was reduced after the introduction of fast track to 31 days. It was easiest to reduce the time up to CEA in our own department and in the neurological departments. The stroke and death rate was unchanged, 4% and 3% before and after fast track respectively.
Conclusion:
The time between symptom and CEA can be shortened by means of a fast track after thorough information and reorganization of the work involving these patients. In order to bring the length of the period below the recommended three weeks, initiatives must be taken especially among specialist outside hospitals and among departments of general internal medicine.
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