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22. European Stroke Conference 335 Vascular surgery and neurosurgery Carotid artery imaging and intervention for symptoms – recurrent stroke in patients turned down at a UK tertiary referral centre M. Nasir1, K. Reid2, R. Davies3, A. Handa4, J. Perkins5, L. Hands6, C. Darby7, D.P.J. Howard8, A. Halliday9 University of Oxford & Dept of Vascular Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UNITED KINGDOM1, University of Oxford & Dept of Vascular Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UNITED KINGDOM2, Dept of Vascu-lar Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UNITED KINGDOM3, Dept of Vascular Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UNITED KINGDOM4, Dept of Vascular Surgery, John Radcliffe Hospital, Oxford University Hospitals, Ox-ford, UNITED KINGDOM5, Dept of Vascular Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UNITED KINGDOM6, Dept of Vascular Surgery, John Radcliffe Hospital, Ox-ford University Hospitals, Oxford, UNITED KINGDOM7, Oxford Stroke Prevention Unit & Dept of Vascular Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UNITED KING-DOM8, Dept of Vascular Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UNITED Background: Carotid artery stenosis can cause stroke. Although delay from symptoms to surgery has decreased over the last 5 years there is little information on why patients with symptomatic dis-ease are turned down for CEA and on their subsequent fate. This data is needed to determine overall benefit from intervention. Methods: Between 2007 & 2012, by including all (7135) patients undergoing carotid duplex im-aging, we investigated reasons for turn down and recurrent events whilst awaiting surgery. Demo-graphics, event type and severity, imaging results, and reasons for not intervening were analysed. Results: 9600 patients were admitted to Oxford with acute cerebrovascular events during the study period. Of 7135 carotid duplex scans performed, 15.3% (1091/7135) revealed significant steno-sis (>60%). Indications for imaging were cerebral ischaemic events 57.6%, ocular events 13.7%, cardiovascular work-up 12.1%, acute confusional states 13.0%, & miscellaneous 3.7%. Of those with significant stenosis, 71.7% (782/1091) were symptomatic. The intervention rate for symptoms was 49.5% (387/782). 6.1% (435/7131) of all scanned had surgery (16.4 scans/CEA). Of 395 pa-tients with symptomatic stenosis turned down for surgery, 63.7% had a clear reason: medically unfit 18.7%, contralateral >60% stenosis or VB stenosis 33.0%, carotid occlusion 27.3%, disabling stroke 1.9%, disabling recurrent event before CEA 3.0%, dementia/patient refusal 11.2%, other 4.9%. 36.3% (143/395) of patients were turned down without an identifiable reason, of which 32.2% had recurrent strokes. Conclusion: Over the last 5-years, ~ 50% of suitable candidates have interventions for symptomat-ic stenosis. However, over 1/3 of patients turned down had no identifiable reason and the recurrent stroke rate in this group was very high. This is important for future stroke prevention. 462 © 2013 S. Karger AG, Basel Scientific Programme


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