774 carotid endarterectomies for strokes and transient ischaemic attacks: comparison of results of early vs. late surgery.

A total of 774 carotid endarterectomies were done; 363 (47%) for completed strokes and strokes with unstable neurological status and 411 (53%) for transient ischaemic attacks. One hundred eight emergency carotid endarterectomies were done in the stroke group for either recurrent strokes or where the lumen of the internal carotid was less than 0.5 mm. Eighty-four emergency carotid endarterectomies were done in the transient ischaemic attack group for either recurrent T.I.A.s or T.I.A.s with carotid lumen less than 0.5 mm. There were 14 (3.8%) deaths in the stroke group and 3 (0.7%) in the transient ischaemic attack group. In the stroke group, the lowest mortality of 1.6% (4 deaths) was in 246 carotid endarterectomies done in the first week, while 87 done in the second week had 3.4% mortality (3 deaths) and 30 done in the third week or later had 23.3% mortality (7 deaths). The highest mortality was in patients with recurrent strokes during the same admission before surgery and in whom surgery was delayed until the third week or later. Primary cause of death was myocardial infarction, pulmonary embolism but not neurological.