Referral to emergency

Irrespective of the presence or absence of carotid artery disease (CAD), for all patients with suspected transient ischaemic attack (TIA)/stroke with symptom onset less than < 4 weeks, please refer to the Stroke and Transient Ischaemic Attack (TIA) - Adult CPC or please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


For patient with amaurosis fugax (transient unilateral loss of vision) and proven carotid stenosis, but no symptoms of stroke or cerebral TIA, please contact the Vascular Registrar via the relevant Local Health Network switchboard.


If your patient is in a life-threatening situation and requires immediate emergency care, call triple zero (000) or visit the nearest emergency department.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the Vascular Registrar on call 24 hours a day, 7 days a week.

For patients who are unstable and require immediate assessment, please refer to the ‘Referral to emergency’ section.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • asymptomatic internal carotid stenosis with < 70% stenosis
  • asymptomatic (radiological) steal syndrome
  • asymptomatic internal carotid occlusion
  • isolated external carotid stenosis
  • pulsatile tinnitus
  • dizziness

Triage categories

Category 1 — appointment clinically indicated within 30 days

  • carotid body tumour confirmed ≥ 2 cm
  • recent history (more than 4 weeks and less than 6 months) of a transient ischaemic attack (TIA), stroke, or amaurosis fugax, WITH an ipsilateral internal carotid artery stenosis greater than > 50%. If less than 4 weeks please see ‘Referral to emergency’ section above.

Category 2 — appointment clinically indicated within 90 days

  • carotid body tumour confirmed ≤ 2 cm
  • asymptomatic internal carotid stenosis with ≥ 70% stenosis on imaging
  • symptomatic subclavian steal syndrome, based on clinical symptoms

Category 3 — appointment clinically indicated within 365 days

  •  nil

Vascular outpatient services accept statewide e-Referrals. For information on e-Referral forms and how to import them, or to download referral forms, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • symptoms of carotid or vertebral disease
  • timing of symptoms
  • current and previous imaging
  • previous carotid intervention
  • complete past medical history
  • current medication list
  • smoking status - if active smoker, strongly consider referral for smoking cessation
  • body mass index (BMI)
  • identifies as Aboriginal and/or Torres Strait Islander
  • identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements 

Additional information to assist triage categorisation

  • complete blood examination (CBE)
  • urea, electrolytes and creatinine (UEC)
  • liver function tests (LFT)
  • estimated glomerular filtration rate (eGFR)

Clinical management advice

Risk factor management in carotid artery disease (CAD) is essential in the treatment and long-term outcomes and can significantly reduce major adverse cardiovascular events including stroke prevention, slow disease progression, improve surgical outcomes, and enhance quality of life. Key interventions can include:

  • atherosclerosis risk factor management including:
    • active blood pressure management and antihypertensives
    • diabetes management
    • dyslipidaemia management aiming for low-density lipoprotein (LDL-C) less than < 1.8mol/L
  • lifestyle modification including:
    • increasing activity levels
    • dietary management
    • weight management
    • smoking cessation, including cigarettes and non-tobacco nicotine products such as e-cigarettes
    • reducing alcohol intake
  • strongly recommending people who smoke stop before surgery as there are significant benefits in perioperative outcomes. Please consider directing your patient to a smoking cessation program.
  • commencing anti-platelet agents
  • commencing all patients with carotid artery disease on a statin regardless of cholesterol levels, adding ezetimibe if required to achieve LDL-C levels less than <1.8mmol/L

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.