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Surgical Referral for Carotid Artery Stenosis — The Influence of NASCET

Published online by Cambridge University Press:  18 September 2015

T.J. Coyne  and
M.C. Wallace
T.J. Coyne*
Affiliation:
Division of Neurosurgery, The Toronto Hospital and University of Toronto, Toronto
M.C. Wallace
Affiliation:
Division of Neurosurgery, The Toronto Hospital and University of Toronto, Toronto
*
Division of Neurosurgery, The Toronto Hospital, 399 Bathurst Sreet, Toronto, Ontario, Canada M5T 2S8
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Abstract:

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A retrospective review was undertaken of 139 consecutive patients with presumed carotid artery stenosis referred to a vascular neurosurgeon. The review period included three years prior and one year subsequent to the publication of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) preliminary results showing surgery to be superior to best medical therapy for patients with symptomatic, high grade (> 70% linear diameter) carotid stenosis. The aims of this analysis were to determine any changes in the referral pattern following the NASCET publication (post-NASCET), and to examine the use and reliability for surgical decision making of pre-referral carotid artery imaging. Patient referral rate increased markedly post-NASCET, particularly from neurologists. There was a trend for more post-NASCET referrals to be for high grade stenosis and fewer referrals to be for intermediate grade (30-69% linear diameter) stenosis, although continued referral of patients with intermediate grade stenosis is desirable as randomization into NASCET continues for this group of patients. Ninety-six patients (69%) were referred with carotid duplex ultrasonography having been performed. There was poor correlation of these results with angiography, which remains necessary for planning management. A majority of patients (65%) referred to this surgical practice did not come to surgery.

Résumé:

RÉSUMÉ:

Nous avons revisé les cas de 139 patients consécutifs référés à un chirurgien vasculaire pour sténose carotidienne. Ces cas avaient été référés sur une période de trois ans avant et d'un an après la publication des résultats préliminaires de l'étude nord-américaine sur l'endartérectomie carotidienne chez les patients symptômatiques (North American Symptomatic Carotid Endarterectomy Trial — NASCET) montrant que la chirurgie était supérieure au meilleur traitement médical chez les patients symptômatiques, porteurs d'une sténose carotidienne sévère (> 70% de diamètre linéaire). Les buts de cette analyse étaient de déterminer s'il y avait eu des changements dans les habitudes de référence suite à la publication de NASCET (post-NASCET) et d'examiner l'utilité et la fiabilité de l'imagerie carotidienne faite avant la consultation en chirurgie vasculaire pour la prise de décision chirurgicale. Le taux de référence a augmenté considérablement post-NASCET, surtout de la part des neurologues. Post-NASCET, les médecins avaient tendance à référer plus de patients avec une sténose sévère et moins de patients avec une sténose modérée (30-69% de diamètre linéaire). Cependant, il est souhaitable que les patients avec une sténose modérée continuent à être référés parce que la randomisation dans l'étude NASCET se poursuit pour ce groupe de patients. L'ultrasonographie duplex carotidienne avait déjà été faite avant la consultation chez quatre-vingt-seize patients (69%). La corrélation avec les résultats de l'angiographie, qui demeure nécessaire à l'établissement d'un plan de traitement, était faible. La majorité des patients (65%) qui nous ont été référés n'ont pas été soumis à la chirurgie.

Type
Articles
Information
Canadian Journal of Neurological Sciences , Volume 21 , Issue 2 , May 1994 , pp. 129 - 132
Copyright
Copyright © Canadian Neurological Sciences Federation 1994

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