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Editor's Choice - The National Norwegian Carotid Study: Time from Symptom Onset to Surgery is too Long, Resulting in Additional Neurological Events.

التفاصيل البيبلوغرافية
العنوان: Editor's Choice - The National Norwegian Carotid Study: Time from Symptom Onset to Surgery is too Long, Resulting in Additional Neurological Events.
المؤلفون: Kjørstad KE; University Hospital of North Norway, Tromsø, Norway. Electronic address: knutek@unn.no., Baksaas ST; Haugesund Hospital, Haugesund, Norway., Bundgaard D; Østfold Hospital, Fredrikstad, Norway., Halbakken E; Vestfold Hospital, Tønsberg, Norway., Hasselgård T; Molde Hospital, Molde, Norway., Jonung T; Haukeland University Hospital, University of Bergen, Bergen, Norway., Jørgensen GT; Bodø Hospital, Bodø, Norway., Jørgensen JJ; Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway., Krog AH; Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway., Krohg-Sørensen K; Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway., Laxdal E; Haukeland University Hospital, University of Bergen, Bergen, Norway., Mathisen SR; Hamar Hospital, Hamar, Norway., Oskarsson GV; Drammen Hospital, Drammen, Norway., Seljeskog S; Akershus University Hospital, Lørenskog, Norway., Settemsdal I; Ålesund Hospital, Ålesund, Norway., Vetrhus M; Stavanger University Hospital, Stavanger, Norway., Viddal BA; Stavanger University Hospital, Stavanger, Norway., Wesche J; University of Oslo, Oslo, Norway; Akershus University Hospital, Lørenskog, Norway., Aasgaard F; St. Olav's University Hospital, Trondheim, Norway., Mattsson E; St. Olav's University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Trondheim, Norway.
المصدر: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2017 Oct; Vol. 54 (4), pp. 415-422. Date of Electronic Publication: 2017 Aug 26.
نوع المنشور: Journal Article; Multicenter Study; Observational Study
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: England NLM ID: 9512728 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2165 (Electronic) Linking ISSN: 10785884 NLM ISO Abbreviation: Eur J Vasc Endovasc Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: 2002-: London : Elsevier
Original Publication: London, UK : W.B. Saunders Co. Ltd., c1995-
مواضيع طبية MeSH: Carotid Stenosis*/complications , Carotid Stenosis*/diagnosis , Carotid Stenosis*/epidemiology , Carotid Stenosis*/physiopathology , Ischemic Attack, Transient*/epidemiology , Ischemic Attack, Transient*/etiology , Ischemic Attack, Transient*/prevention & control , Stroke*/epidemiology , Stroke*/etiology , Stroke*/prevention & control , Time-to-Treatment*/standards , Time-to-Treatment*/statistics & numerical data, Endarterectomy, Carotid/*methods , Platelet Aggregation Inhibitors/*therapeutic use, Aged ; Endarterectomy, Carotid/statistics & numerical data ; Humans ; Male ; Middle Aged ; Needs Assessment ; Norway/epidemiology ; Prospective Studies ; Risk Assessment/methods ; Severity of Illness Index ; Symptom Assessment/statistics & numerical data
مستخلص: Objective/background: The objective was to observe for 1 year all patients in Norway operated on for symptomatic carotid stenosis with respect to (i) the time from the index event to surgery and neurological events during this time; (ii) the level in the healthcare system causing delay of surgical treatment; and (iii) the possible relationship between peri-operative use of platelet inhibitors and neurological events while awaiting surgery.
Methods: This was a prospective national multicentre study of a consecutive series of symptomatic patients. Patients were eligible for inclusion when referred for surgery. An index event was defined as the neurological event prompting contact with the healthcare system. All 15 departments in Norway performing carotid endarterectomy (CEA) participated.
Results: Three hundred and seventy one patients were eligible for inclusion between 1 April 2014 and 31 March 2015, and 368 patients (99.2%) were included. Fifty-four percent of the patients contacted their general practitioner on the day of the index event. Primary healthcare referred 84.2% of the patients to hospital on the same day as examined. In hospital median time from admission to referral for vascular surgery was 3 days. Median time between referral to the operating unit and actual CEA was 5 days. Overall, 61.7% of the patients were operated on within 2 weeks of the index event. Twelve patients (3.3%) suffered a new neurological event while awaiting surgery. The percentage of patients on dual antiplatelet therapy was lower (25.0%) in this group than among the other patients (62.6%) (p = .008). The combined 30 day mortality and stroke rate was 3.8%.
Conclusion: This national study with almost complete inclusion and follow-up shows that the delays occur mainly at patient level and in hospital. The delay is associated with new neurological events. Dual antiplatelet therapy is associated with reduced risk of having a new neurological event before surgery.
(Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)
التعليقات: Comment in: Eur J Vasc Endovasc Surg. 2017 Oct;54(4):413-414. (PMID: 28888385)
فهرسة مساهمة: Keywords: Carotid stenosis; Carotid surgery; Platelet inhibitors; Stroke; Symptomatic; Timing
المشرفين على المادة: 0 (Platelet Aggregation Inhibitors)
تواريخ الأحداث: Date Created: 20170829 Date Completed: 20180126 Latest Revision: 20180126
رمز التحديث: 20231215
DOI: 10.1016/j.ejvs.2017.07.013
PMID: 28844552
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-2165
DOI:10.1016/j.ejvs.2017.07.013