The value of a joint cerebrovascular neurology clinic in carotid surgery practice

Objectives: The aims of the clinic were to offer suitable patients carotid endarterectomy with minimal delay, to discuss patients with unclear symptoms and to offer the best advice to patients referred with asymptomatic carotid artery stenosis.
Design: A retrospective note review of all the patients who attended the clinic over a two-year period between January 1997 and December 1998 was undertaken. A pro-forma was completed.
Participants: Three hundred and ninety-nine patients who were seen in the joint clinic for investigations of cerebrovascular disease.
Main outcome measures: Waiting time for specialist consultations and treatment.
Results: During that period 118 new patients and 281 follow-up patients were seen in the clinic. Colour flow Doppler was performed on 102 new patients and 113 follow-up patients. Digital Subtraction Angiography was used in selected patients (16). Sixty -six patients had combined consultations. Twenty-nine (24.6%) patients were assessed and discharged from the clinic on their first consultation. Seventy-three (62%) patients were listed for carotid endarterectomy. The mean waiting time from referral to consultation was 2.6 weeks and from consultation to surgical treatment was 4.7 weeks. Both these waiting times were significantly better than the waiting times before the joint cerebrovascular neurology clinic was set up.
Conclusion: The combined clinic provided an appropriate environment for one-stop rapid assessment and treatment of patients with preventable stroke.

Keywords
Joint clinic, Carotid endarterectomy, Stroke prevention, Transient ischaemic attack