ARE POST STROKE/TRANSIENT ISCHAEMIC ATTACK CAROTID INVESTIGATION BEST PRACTICE GUIDELINES BEING FOLLOWED IN MAYO UNIVERSITY HOSPITAL?

Abstract Ref: 
0285

Sean McKernan, Tom O’Malley

Mayo University Hospital, Castlebar, Ireland

Background: Following onset of cerebral ischaemia (Stoke/TIA) extracranial imaging is
recommended to assess for presence of stenosis of the carotid arteries. Interaction
between future cerebral ischaemia caused by carotid stenosis and treatment with carotid
endarterectomy was investigated in the European Carotid Surgery Trial and North
American Symptomatic Carotid Endarterectomy Trial. This study aims to determine if
best practice guidelines of the Royal College of Physicians - UK were followed in Mayo
University Hospital regarding investigation of Carotid Stenosis following Cerebral
Ischaemia.

Methods: Consecutive cases identified as having had a carotid doppler were selected
between January - June 2017. Following obtaining ethical approval, patient imaging and
symptomology from imaging and computerised discharge systems were queried. 82
patients met inclusion criteria with data collected and follow up determined from patient
charts. Data was compared to a previous audit in 2007/2008 involving 103 patients.

Results: Of 82 patients (39 male, 43 female) presenting with Stroke/TIA symptoms or
imaging confirming cerebral ischaemia, 38 (46.3%) had carotid investigation within the
recommended guideline timeframe (1 day) with the average time between presentation
and investigation being 5.15 days (range 0 - 77 days). Of the 10 patients (12.1%) found
to have haemodynamically significant stenosis on carotid imaging, 6 patients (7%) went
on to have dual modality carotid imaging as per guidelines. 57 patients (69.5%) were
managed by a stroke physician while an inpatient. Compared to previous audit results
34% had carotid dopplers within 2 weeks of presentation.

Conclusion: Compared to previous audit results improvement has been made in presentation
to carotid imaging time with 90% of imaging reported as normal within a system
with no dedicated fast track service. A small number received dual imaging in accordance
with guidelines showing evidence that a more streamlined stroke service could reduce
strain on hospital resources.