Delay may reduce procedural risk, but at what price to the patient?

The renewed strategy towards performing carotid endarterectomy (CEA) within 1-2 weeks of a patient presenting with a TIA or minor stroke is based on a large body of evidence showing that the highest risk period for the patient is the first seven days after the index event. Unfortunately, most stroke/vascular services are inadequately resourced to achieve this target and many are more likely to be pre-occupied with treating large numbers of asymptomatic individuals. This paper reviews the evidence underlying the current drive towards expedited intervention in patients presenting with TIA and minor stroke. It will also try to provide reassurance to the surgeon as to how such a strategy can be reconciled with understandable concerns that early CEA in symptomatic patients is associated with poorer perioperative outcomes.