Changes required to improve CEA outcomes

We read with interest this article regarding improving the provision of carotid endarterectomy (CEA). As noted, achieving a 2-week target requires a change in practice as well as ‘motivated’ surgeons. Historically, CEA was performed more frequently by some surgeons in our unit (7 in total) than others, reflecting referral practices and ‘special’ interests. In order to meet the 2-week target, we developed a policy that all symptomatic patients requiring CEA would be accommodated on the next available consultant operating list. Over the last 6 months, we have achieved 97% compliance with the 2-week target. With increasing centralisation, many centres now have ‘vascular’ lists most days. We would, therefore, recommend our unit's policy to others particularly since a recent national audit suggests little improvement in CEA provision since the 2-week time limit was published.1 In addition, the greatest risk of stroke is within the first few days following the index neurological event2 and awareness amongst the public and GPs regarding the significance of transient ischaemic attacks is poor;3 greater steps are required to identify ‘brain attacks’ early through public awareness campaigns and physician education. We believe that this and the suggested changes in service provision are required to improve overall outcomes.