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Multicenter Study
. 2010 Nov;92(8):647-50.
doi: 10.1308/003588410X12699663904916. Epub 2010 Jul 7.

RACE to protect brains

Thomas E Rix  1 , Inderjit Singh, Robert Insall, Jawaharlal Senaratne
Affiliations
Multicenter Study

RACE to protect brains

Thomas E Rix et al. Ann R Coll Surg Engl. 2010 Nov.

Abstract

Introduction: Rapid-access carotid endarterectomy (RACE) is an evidence-based treatment for symptomatic carotid stenosis. Our vascular centre aims to provide this service within 48 h of symptoms in appropriate patients. This study audits safety and efficacy of the first year of RACE.

Subjects and methods: A clear trust protocol was publicised for the RACE pathway. A prospective database was established for all carotid endarterectomies (CEAs) performed. Outcomes were compared between elective (ECE) and rapid-access operations.

Results: In 1 year, 96 patients received CE; 20 were performed urgently. There were no significant differences in age or gender between ECE and RACE groups. Twenty-three (30%) of ECE were for asymptomatic stenoses; no other significant differences in surgical indication were seen. Of symptomatic ECE, 43% were for completed stroke versus 55% for RACE. Median delay between diagnosis and surgery was 113 days for elective and 2 days for RACE patients. There was one death following ECE (1.3%) and one stroke after RACE (5%), all not significant. Anaesthetic method did not influence outcome. The main reasons for delaying surgery in RACE patients were optimisation of patient fitness and availability of theatre time.

Conclusions: The RACE pathway dramatically reduces delay without compromising patient safety. In the first year of service, we have treated 50% of suitable patients within 48 h. Further education of patients and colleagues should reduce delay and improve outcomes for symptomatic carotid disease.

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Figures

Figure 1
Figure 1
Median delays from symptoms to surgery. Note East Kent data show delay from diagnosis to surgery.
See this image and copyright information in PMC

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