Hernan A. Bazan, Gentry Caton, Sharzad Talebinejad, Ross Hoffman, Taylor Smith, Elizabeth Holt, Gabriel Vidal, Kenneth Gaines, W Charles Sternbergh III
Ochsner Clinic, New Orleans, LA.
OBJECTIVES: Patients presenting with carotid-related acute neurological symptoms are at heightened risk of stroke. Urgent CEA (uCEA) during the index hospitalization is indicated in select patients. We aimed to determine the effect of a dedicated vascular neurology team on the volume of uCEAs and assess outcomes.
METHODS: CEAs (n=436) performed at a tertiary center between 2005-2011 were analyzed. Chi-square was used to compare the uCEA volume pre- (June 2005-Aug. 2008) and post- (Sept. 2008-Nov. 2011) implementation of a vascular neurology service. Fisher’s exact and t-tests were used to analyze perioperative outcomes.
RESULTS: The proportion of uCEAs performed increased significantly after initiation of a vascular neurology service (4.1% [7/172] vs. 22.2% [49/221], p< .0001). Per annum, uCEAs increased from 5.3% (4/75) in 2005 to 39.6% (25/63) in 2011 (Figure). uCEA indications were stroke-in-evolution 10% (5/49), crescendo TIAs 6% (3/49), acute stroke 45% (22/49), and cerebral/ocular TIAs 39% (19/49). Mean National Institutes of Health Stroke Scale (NIHSS) was 3.5 (0-24); mean TIA score was 5 (1-8). A trend towards a higher combined stroke/death rate in the urgent compared to the elective symptomatic CEA group was present (7.1 % [3/49] vs. 2% [1/49]; p=.36); however, patients undergoing uCEA with an NIHSS<10 had no perioperative complications.
CONCLUSIONS: Collaboration with a vascular neurology team increased the volume of uCEAs over a three-year period. In patients with mild strokes (NIHSS<10), uCEA outcomes approximate those for electively-performed CEAs.
AUTHOR DISCLOSURES: H. A. Bazan, Nothing to disclose; G. Caton, Nothing to disclose; K. Gaines, Nothing to disclose; R. Hoffman, Nothing to disclose; E. Holt, Nothing to disclose; T. Smith, Nothing to disclose; W. Sternbergh III, Nothing to disclose; S. Talebinejad, Nothing to disclose; G. Vidal, Nothing to disclose.
*September 2008: Vascular neurology service implementation
Posted April 2012