Optimising the Timing of Carotid Surgery using a Carotid Risk Scoring System

Abstract 

Objectives

Transient ischaemic attacks (TIA's) have 4–20% risk of evolving into a major stroke within 90 days, with half of them occurring in the first 2 days. The Department of Health, UK, guidelines (2007) suggests all higher-risk patients with TIA and minor stroke need to be assessed by a specialist and treated within 24 hours. However, the reality in the health system is that the delay between the last cerebrovascular event (CVE) and surgery is often in excess of 90 days. Recently validated ABCD² scoring stratifies the risk of stroke after CVE and can help in prioritizing patients for investigations and urgent carotid endarterectomy (CEA).

The aim of this pilot study was to stratify patients who underwent CEA, post cerebrovascular event, using the ABCD² scoring method. This would help us assess our current CEA practice and, in future, prioritise surgery according to estimated stroke risk.

Design & methods

Retrospective analysis of ABCD² scoring of patients who underwent CEA.

Results

The average delay between first presentation and carotid endarterectomy was 172.8 days (range 3 to 837 days). This average delay for the low, moderate and high risk groups was 200.8, 154.1 and 156.5 days, respectively.

Conclusion

The ABCD² scoring is an easily applicable method to stratify patients post CVE at risk of further stroke. Our results suggest that to maximize the benefit of CEA within a limited resource health system, patients with a high ABCD² score should be given the highest priority for investigations followed by CEA.

Keywords: Carotid Endarterectomy, ABCD² scoring, Stroke risk scoring, Transient ischaemic attack scoring