Is there a role for carotid surgery in acute stroke?
BACKGROUND
Carotid endarterectomy reduces the risk of stroke in patients with a history of minor ischemic stroke or transient ischaemic attacks and severe carotid stenosis, but the timing of surgery following acute stroke is controversial. Urgent carotid surgery in acute stroke may reduce the risk of early stroke recurrence due to further emboli from the diseased carotid, or may improve neurological recovery by improving cerebral blood flow to the ischaemic penumbra.


METHODS
We identified from the literature patients undergoing carotid surgery in acute stroke using a Medline search and identifying references from these sources.


RESULTS
Over 2000 patients were identified from the literature who underwent acute carotid surgery. Heterogeneous groups of patients were recruited, with no control patients treated medically in the majority of the studies. Mortality and morbidity was highly variable and depended primarily on the initial severity of the neurological deficit, with lower mortality in patients with minor neurological deficits.


CONCLUSIONS
The role of carotid surgery in acute stroke is uncertain. A multicentre randomised controlled trial is now required to assess the value of acute carotid surgery.
Mead
G E
GE
University Department of Surgery, University Hospital of South Manchester, West Didsbury, U.K.
O'Neill
P A
PA
McCollum
C N
CN
D000208:Acute Disease; D002561:Cerebrovascular Disorders / Q000517:prevention & control*; D016894:Endarterectomy, Carotid; D006801:Humans; D012008:Recurrence