The timing of carotid endarterectomy after acute stroke.

Evidence exists that carotid artery endarterectomy prevents a second stroke in those patients who initially present with a stroke. However, the timing of the operation is controversial. Some authors advise a delay of 6 weeks, and others recommend an early endarterectomy as soon as the patient is clinically stable. The clinical studies addressing this problem are retrospective and nonrandomized, providing no definite answers. But they do provide some guidance. It is probably safe to perform early endarterectomy in clinically stable patients with negative computed tomography (CT) scans. Delay is recommended for more serious neurological events with positive CT scans. Early operation may also be indicated in patients with a significant threatening carotid arterial lesion.