INTRODUCTION: Rapid-access carotid endarterectomy (RACE) is an evidence-based treatment for symptomatic carotid stenosis. Our vascular centre aims to provide this service within 48 h of symptoms in appropriate patients. This study audits safety and efficacy of the first year of RACE. SUBJECTS AND METHODS: A clear trust protocol was publicised for the RACE pathway. A prospective database was established for all carotid endarterectomies (CEAs) performed. Outcomes were compared between elective (ECE) and rapid-access operations. RESULTS: In 1 year, 96 patients received CE; 20 were performed urgently. There were no significant differences in age or gender between ECE and RACE groups. Twenty-three (30%) of ECE were for asymptomatic stenoses; no other significant differences in surgical indication were seen. Of symptomatic ECE, 43% were for completed stroke versus 55% for RACE. Median delay between diagnosis and surgery was 113 days for elective and 2 days for RACE patients. There was one death following ECE (1.3%) and one stroke after RACE (5%), all not significant. Anaesthetic method did not influence outcome. The main reasons for delaying surgery in RACE patients were optimisation of patient fitness and availability of theatre time. CONCLUSIONS: The RACE pathway dramatically reduces delay without compromising patient safety. In the first year of service, we have treated 50% of suitable patients within 48 h. Further education of patients and colleagues should reduce delay and improve outcomes for symptomatic carotid disease.
INTRODUCTION: Rapid-access carotid endarterectomy (RACE) is an evidence-based treatment for symptomatic carotid stenosis. Our vascular centre aims to provide this service within 48 h of symptoms in appropriate patients. This study audits safety and efficacy of the first year of RACE. SUBJECTS AND METHODS: A clear trust protocol was publicised for the RACE pathway. A prospective database was established for all carotid endarterectomies (CEAs) performed. Outcomes were compared between elective (ECE) and rapid-access operations. RESULTS: In 1 year, 96 patients received CE; 20 were performed urgently. There were no significant differences in age or gender between ECE and RACE groups. Twenty-three (30%) of ECE were for asymptomatic stenoses; no other significant differences in surgical indication were seen. Of symptomatic ECE, 43% were for completed stroke versus 55% for RACE. Median delay between diagnosis and surgery was 113 days for elective and 2 days for RACE patients. There was one death following ECE (1.3%) and one stroke after RACE (5%), all not significant. Anaesthetic method did not influence outcome. The main reasons for delaying surgery in RACE patients were optimisation of patientfitness and availability of theatre time. CONCLUSIONS: The RACE pathway dramatically reduces delay without compromising patient safety. In the first year of service, we have treated 50% of suitable patients within 48 h. Further education of patients and colleagues should reduce delay and improve outcomes for symptomatic carotid disease.
Authors: J A DeWeese; C G Rob; R Satran; D O Marsh; R J Joynt; E O Lipchik; D N Zehl Journal: J Cardiovasc Surg (Torino) Date: 1971 Jul-Aug Impact factor: 1.888
Authors: H H Eckstein; P Ringleb; A Dörfler; K Klemm; B T Müller; M Zegelman; H Bardenheuer; W Hacke; T Bruckner; W Sandmann; J R Allenberg Journal: J Vasc Surg Date: 2002-11 Impact factor: 4.268
Authors: P M Rothwell; M Eliasziw; S A Gutnikov; A J Fox; D W Taylor; M R Mayberg; C P Warlow; H J M Barnett Journal: Lancet Date: 2003-01-11 Impact factor: 79.321
Authors: K D Wölfle; K Pfadenhauer; H Bruijnen; T Becker; M Engelhardt; C Wachenfeld-Wahl; E Schulze-Hamma; H Loeprecht; W A Wohlgemuth Journal: Vasa Date: 2004-02 Impact factor: 1.961
Authors: Alison W Halliday; Tim Lees; Dora Kamugasha; Robert Grant; Alex Hoffman; Peter M Rothwell; John F Potter; Michael Horrocks; Ross Naylor; Anthony G Rudd Journal: BMJ Date: 2009-06-04