Carotid Artery Operation Delay During the Covid-19 Pandemic: Results of a Multicenter International Study

Background: To measure the impact of the COVID-19 pandemic on the management of pa-tients with carotid artery stenosis.Methods: We prospectively collected data from 25 centers (19 centers in the United States and 6 centers internationally) on postponed carotid artery operations between March 2020 and January 2022. We describe the characteristics of these patients and their planned operations, along with outcomes including mortality and neurological deterioration during the period of oper-ative delay due to the COVID-19 pandemic.Results: A total of 1,220 vascular operations were postponed during the pandemic, of them 96 patients presented with significant carotid stenosis (median stenosis of 71%; interquartile range; 70e80) and 80% of them were planned for carotid endarterectomy. Most patients were asymp-tomatic (69%), and 31% of patients were symptomatic (16% of patients had a stroke, 15% of patients had a transient ischemic attack, and 1% of patients experienced amaurosis fugax). The median length of surgical delay was 71 days (interquartile range: 45.5, 115.5). At the data entry time, 62% of patients had their carotid operations postponed and successfully completed. Most postponements (72%) were due to institutional policies aimed at resource con-servation. During the delay, no patient decompensated or required an urgent operation. A total of 5 patients (5%) with carotid stenosis died while awaiting operations due to COVID-19. Conclusions: Our study of a cohort of patients with carotid artery stenosis who underwent a median delay of 71 days during the COVID-19 pandemic showed a disparate operation delay between US regions and internationally, most postponements were due to hospital policy, and none of the patients deteriorated or required an emergency surgery during the delay.

Automated summary

The study found that during the COVID-19 pandemic, delays in carotid artery operations were primarily due to hospital policies, with most patients not deteriorating or requiring emergency surgery during the delay.