Re-Audit: Carotid

Endarterectomy
Waiting Times
Sufyan Faruq
Mario Metry
Mr Sowinski
Aims & Objectives
Audit looking at patients who were admitted following
stroke/TIA and then went on to have carotid
endarterectomies

Carotid endarterectomies performed between March

2014 and Feb 2015

Comparing referral times and waiting times for

endarterectomies with to national stroke gudelines.
Standards
National Clinical Guidelines 2009 Stroke: The
diagnosis and acute management of stroke and
transient ischaemic attacks by the National
Institute for Health and Clinical Excellence
http://www.nice.org.uk/Guidance/CG68
 People with stable neurological symptoms from acute
non-disabling stroke or TIA who have symptomatic
carotid stenosis of 5099% according to the NASCET
criteria, or 7099% according to the ECST criteria,
should:

1. Be assessed and referred for carotid endarterectomy

within 1week of onset of symptoms

2. Undergo surgery within a maximum of 2weeks of

onset of symptoms
 National Stroke Strategy 2007

Carotid imaging should ideally be performed at initial

assessment and should not be delayed for more than
24 hours after first clinical assessment in TIA or
minor stroke patients at higher risk of stroke (e.g.
ABCD2 score >4)

Carotid intervention for recently symptomatic severe

carotid stenosis should be regarded as an
emergency procedure in patients who are
neurologically stable, and should ideally be
performed within 48 hours of a TIA or minor stroke.
Continue
30 patients in total
18 Elective 12 Emergency
21 Male 9 Female
Time from symptom onset to scan (days)

3
8
less than or equal to 1
1 2 to 7
7 to 14
15 to 30
>30

16
Time from symptom onset to referral (days)

20

3 less than or equal to 7

8 to 14
15 to 30
57 >30

20
 Time From Symptom Onset to Surgery (days)

20
23

less than or equal to 7

7 to 14
15 to 30
20
>30

47
80

70
70

60
60

50
Time from symptom onset to surgery
(days audit 1 (CIC)(%)
40 37 Time from symptom onset to surgery
36
(days audit 1 (WCH)(%)
Time from symptom onset to surgery
30 (days audit 2 (%)
23
20 20 20
20

10
10

0
<14 15 to 30 >30
 Time from referral to surgery (days)

13

10

less than or equal to 7

7 to 14
15 to 30
>30
10

67
 Time from Referral to Surgery (Days)
70
67

60

50

43
40
40
Audit 1 (CIC) (%)
Audit 1 (WCH) (%)
29 30
30 Audit 2 (%)

20
20

13
10 10 10
10 7 7

0
<7 7 to 14 15 to 30 >30
Conclusion
57% of patients met NICE guidelines and
were referred for Carotid Endartdectomy
within 1 week of symptom onset

60% of patients had their surgery within 2

weeks of symptom onset compared to the
previous audit 36%(CIC) and 20%(WCH)

67% had surgery within one week of

referral compared to previous audit 29%
(CIC) & 10%(WCH)
 Significant improvement in number of
patients being referred and undergoing
carotid intervention within targets set out
within the NICE, when compared with last
years audit

27% had carotid imaging within 24 hours

of initial assessment as recommended in
the Dept of Health Stroke Strategy 2007

Only 3% met the Stroke Strategy standard

of performing CEA within 48 hours of
symptoms (same percentage as previous
audit)
Interventions
Standardised referral protocols to minimise delays
Greater access to carotid imaging services
Greatest delay seems to be in referring of patients
for CEA - ?Further audit required
Thank You