Optimization of the timing of carotid endarterectomy

Abstract

Carotid endarterectomy reduces the risk of stroke in patients with symptomatic carotid artery stenosis, but the optimum time to perform surgery has been uncertain. A large study has shown that surgery within 2 days of stroke or transient ischaemic attack has an unacceptable complication rate, but is safe thereafter.

Response to commentary on ‘Transcranial Doppler Microemboli for Case Selection in Asymptomatic Carotid Stenosis’

“…The focus of care is now directed towards identifying the high-risk patient, brain, or plaque where intervention will have the most benefit in a timely manner. 2 The data in this meta-analysis propose TCD to be utilised for this benefit in a given patient who has carotid artery disease. The underlying aim of TCD is to identify those patients at higher or lower risk of subsequent stroke, and is therefore applicable to all patients with carotid disease.…”

New national guideline for stroke management: where do we go from here?

“…The ideal time to perform surgery appears to be 3-14 days after the onset of symptoms. 5 Some of the recommendations are inevitably based on research done over 20 years ago, which may well be out of date. For example, the guideline recommends that the final decisions regarding carotid endarterectomy should be supported by risk tables or the web-based risk calculator available from the Oxford University Stroke Prevention Research Unit.…”