Screening with doppler ultrasound for carotid artery stenosis in patients with stroke or transient ischaemic attack
Tatiana Kristensen1,2, Peter Hovind1, Helle K Iversen3
1Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Glostrup, Denmark.
Insights
This study found that a screening program for carotid artery stenosis in stroke patients met national time recommendations. Carotid endarterectomy was performed promptly, with no delays preventing surgery.
Area of Science:
- Vascular Surgery
- Neurology
- Public Health
Background:
- Carotid endarterectomy for symptomatic internal carotid artery stenosis in stroke patients reduces recurrent stroke risk.
- Timely intervention, ideally within 2 weeks of the initial event, is crucial for optimal outcomes.
Purpose of the Study:
- To evaluate the efficiency of a Doppler ultrasound screening program for carotid stenosis in hospitalized stroke and transient ischemic attack patients.
- To assess adherence to national recommendations regarding referral to vascular surgeons and timely carotid endarterectomy.
Main Methods:
- Prospective study of consecutive patients hospitalized with transient ischemic attack or stroke over one year.
- Carotid Doppler ultrasound screening was performed to identify stenosis or occlusion.
Main Results:
- 1390 patients were screened; 12.3% had significant carotid stenosis or occlusion.
- 87% of patients with stenosis were referred to vascular surgery within 4 days of admission.
- 16 patients underwent carotid endarterectomy, all within 14 days, with no exclusions due to procedural delays.
Conclusions:
- The screening program effectively met the national 4-day time limit for carotid stenosis screening in stroke patients.
- The 14-day time limit for carotid endarterectomy was also met, ensuring no patient was excluded due to delays.
- Only 1.2% of all screened patients ultimately underwent carotid endarterectomy.
Introduction:
Carotid endarterectomy of symptomatic internal carotid artery stenosis in patients with stroke or transient ischaemic attack reduces the risk of recurrent stroke, particularly if performed within 2 weeks from the first event. We evaluated the efficiency of a screening programme based on Doppler ultrasound in patients hospitalized with stroke or transient ischaemic attack in the stroke centre at Rigshospitalet, Glostrup, Denmark, concerning timeliness of referral to the vascular surgeon and performance of carotid endarterectomy according to national recommendations.
Methods:
Prospective study of a consecutive cohort of patients with transient ischaemic attack or stroke, referred for carotid Doppler ultrasound over a one-year period.
Results:
We examined 1390 patients (1048 with stroke, 342 with transient ischaemic attack), 71% within 24 h and 93% within 4 days after admission. Carotid stenosis or occlusion was found in 171 patients (12·3%) and was hemisphere related in 78 patients (5·6%). Among these, 68 (87%) were referred to the vascular department, 94% within 4 days of admission. Carotid endarterectomy was performed in 16 patients, all within 14 days from admission, and was not declined in any patient due to procedural delay.
Conclusions:
In a major Danish stroke centre, the national recommended time limit of 4 days in patients with stroke or transient ischaemic attack for screening for carotid stenosis was met in almost all patients. No patients were excluded from surgery as a result of a time limit of 14 days from admission to surgery being exceeded. Of all patients screened, 1·2% underwent carotid endarterectomy.
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