Related Experiment Video
Updated: Feb 18, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Carotid endarterectomy: the change in practice over 11 years in a stroke centre
Gabrielle T W Tse1, Monique F Kilkenny2,3, Chris Bladin1,4
1Department of Neurosciences, Eastern Health, Melbourne, Victoria, Australia.
Insights
Carotid endarterectomy (CEA) practice shifted towards increased use and faster surgical timing, with stable outcomes despite changing patient selection and imaging trends. This reflects evidence-based practice evolution in stroke care.
Area of Science:
- Vascular Surgery
- Neurology
- Health Services Research
Background:
- Recent research has influenced carotid endarterectomy (CEA) practices.
- Understanding temporal changes in CEA practice and outcomes is crucial.
Purpose of the Study:
- To characterize changes in the practice and outcomes of CEA over time.
- To analyze trends in patient selection, intervention choice, and surgical timing.
Main Methods:
- Retrospective analysis of patients undergoing CEA (2004-2014) and carotid angioplasty and stenting (CAS) (2003-2008).
- Inclusion of data from a large Australian metropolitan tertiary stroke center.
- Analysis of clinical data for time trends in intervention choice, patient selection, imaging, surgical timing, and outcomes.
Main Results:
- CEA proportion increased from 60% to 90% compared to CAS (2004-2008).
- CEA patients trended older (≥80 years) and less asymptomatic over time.
- Surgical timing improved significantly, decreasing from median 52 days to 8 days.
- Preoperative ultrasonography use decreased, while CT angiography and multi-modality imaging increased.
- Overall complication rates (death, stroke, MI) remained stable at 5.9%.
Conclusions:
- Observed CEA practice trends align with international guidelines and evidence translation.
- The study serves as an indicator of Australian hospital practices in stroke care.
- Demonstrates the integration of research evidence into clinical decision-making for cerebrovascular disease.
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 ≥80 years 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 52 days (Q1: 25, Q3: 74) in 2004 to 8 days (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.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care