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Many at High Risk for Stroke Don't Get Timely Surgery

Focus on intravenous thrombolysis may divert resources from other stroke care

FRIDAY, June 5 (HealthDay News) -- Most patients in the United Kingdom at high risk for stroke do not receive carotid endarterectomy within the recommended two weeks from onset of symptoms, according to a study published online on June 5 in BMJ, while a related analysis says the U.K. government's emphasis on acute stroke may come at the expense of resources and attention for other elements of stroke care.

Alison W. Halliday, of the University of London in the United Kingdom, and colleagues analyzed data from 240 consultant surgeons on 9,913 carotid endarterectomies, of which 5,513 were included in the study. In all, 83 percent of the patients who underwent endarterectomy had a history of stroke or transient ischemic attack, but of those, only 20 percent underwent surgery within two weeks of onset of symptoms, and there was a more than 12-week wait for 30 percent of the patients, the researchers found.

Cathie Sudlow, of the University of Edinburgh in the United Kingdom, and a colleague write that, based on a U.K. population of one million, stroke unit care and aspirin are preventing 37 and 24 poor outcomes, respectively, in acute stroke patients each year. But if there was a 5 percent increase in stroke patients treated with intravenous thrombolysis within three hours, then 11 would avoid a poor outcome, and higher rates of stroke unit admission and early aspirin administration would result in 59 and 29 patients avoiding a poor outcome, respectively.

"Although operative mortality rates are comparable with those in other countries, some patients might experience disabling or fatal stroke while waiting for surgery and hence not be included in operative statistics," Halliday and colleagues write. "Major improvements in services are necessary to enable early surgery in appropriate patients in order to prevent strokes."

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