Identifying Optimal Pathways of Care in the Delivery of Carotid Interventions

Cardiovascular disease is a major cause of morbidity and mortality worldwide. Cardiovascular interventions can also carry a significant risk of morbidity and mortality. As with most surgical specialties, careful patient selection is important for a good outcome. Whilst long-term benefit is achieved in most patients, no studies have examined the peri-procedural risks of cardiovascular interventions. By using a variety of different research methodologies, it may be possible to identify subgroups of patients at increased risk of complications following cardiovascular intervention.

The objective of this DPhil project is to define the optimal clinical pathway for patients undergoing Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS). The aims will be three-fold:
1. Identify hospital-level structural factors that affect outcomes following CEA and CAS by performing a systematic review;
2. Define the carotid intervention pathway for symptomatic patients by performing an ethnographic observational study prior to undertaking a Healthcare Failure Mode and Effect Analysis (HFMEA);
3. Use Hospital Episode Statistics (HES) data to assess how the provision and outcomes following CEA and CAS have changed temporally, identify geographical variation within England and Wales and investigate the effects of socio-economic status, ethnicity and common vascular co-morbidities on outcomes following carotid intervention

This DPhil project will combine several methodologies to further our understanding of the carotid intervention pathway and suggest evidence-based recommendations to improve outcomes in this high-risk group of patients.