Fairhead JF et al. (2005) Population-based study of delays in carotid imaging and surgery and the risk of recurrent stroke. Neurology 65: 371–375

It is now well established that carotid endarterectomy is of most benefit when performed promptly after a stroke or transient ischemic attack. As soon as 2 weeks after the event, the risk of recurrent stroke rises sharply. Nevertheless, studies have shown that delays to endarterectomy are common. This point is underlined in a recent study, which also questions the reasons for such delays and assesses the consequences.

The first part of the analysis included 853 patients (from a total population of approximately 690,000 in Oxfordshire, UK), who underwent carotid imaging following a retinal or cerebral transient ischemic attack or stroke. The median interval between the presenting event and referral for carotid imaging was 9 days, and a median interval of 33 days was noted between the event and imaging actually taking place. Importantly, a median of 100 days elapsed between presentation and endarterectomy. Next, the investigators recorded the incidence of recurrent stroke prior to surgery in 38 patients with ≥50% symptomatic carotid stenosis. This analysis revealed an increase in the risk of recurrent stroke from 21% at 2 weeks after the event, to 32% at 12 weeks.

Authors Fairhead et al. note that these delays to carotid imaging and endarterectomy are similar to those seen elsewhere, and are mostly accounted for by secondary care. They urge that surgery, if appropriate, should be carried out within 1 week of the presenting event, to minimize the risk of recurrent stroke.