Background Although the indications for carotid endarterectomy
(CEA) are clearly defined by major trials, CEA
has not been properly implemented in many developing
regions, including Northern Africa represented in this study
by Upper Egypt. This study was designed to estimate the
need for CEA in symptomatic patients with significant
internal carotid artery stenosis in Upper Egypt. The estimated
needs and actual provision of CEA in Upper Egypt
were compared with those of Uusimaa (Finland) and
Wessex (England) regions, representing Northern Europe.
Methods Incidence rates were derived from a community-
based door-to-door survey in Upper Egypt, Oxford
Community Stroke Project, and epidemiological Finnish
studies. The provision of CEA was derived from the local
registry of Vascular Surgery Department, Assiut University
Hospitals in Upper Egypt; HUSVASC data registry at
Helsinki University Central Hospital, and the published
data of the Wessex region. The estimated needs were calculated
using previously published proportions of patients
eligible for CEA.
Results The population at risk of cerebral ischemic events
(C65 years old) is 4% of the Egyptian population compared
with 16% and 15% of the British and Finnish populations,
respectively. The incidence of stroke and transient
ischemic attack (TIA) is comparable in England and Finland
but higher than the Egyptian rates (1.9%and 2.1%vs.
1.2% for stroke; 0.5% and 0.6% vs. 0.2% for TIA,
respectively). The ratio of the actual provision of CEA to
the estimated need in Wessex and Uusimaa is the same
(0.5), whereas it is much lower (0.003) in Upper Egypt.
Conclusions Despite the low incidence of stroke and
TIA, there is a huge unmet need for CEA in Upper Egypt.
Yet, Wessex and Uusimaa also seemed to be at a suboptimal
level compared with the estimated need. If CEA
could be offered annually to those 1,650 patients with
severe symptomatic ICA stenosis, 275 strokes could be
prevented in Upper Egypt in 5-year duration, provided that
the operative morbidity and mortality rates are equal to
those reported in the large, randomized, controlled trials.