title: Carotid intervention following transient ischaemic attack: What are we waiting for?
abstract: Transient ischaemic attack secondary to carotid stenosis has the highest risk of stroke recurrence compared with other aetiological subtypes. International guidelines advocate carotid intervention within one to two weeks of the index neurological event. Traditionally, delayed carotid intervention was perceived to be a safer management strategy, yet classic trials of endarterectomy and recent meta-analysis of carotid intervention demonstrate the safety of hyperacute carotid intervention. Data from international studies suggest that targets are not being met, the reasons for which are multifactorial, but patients suffering transient or ocular symptoms are particularly delayed. Efforts should be made to conduct regional studies investigating the root causes of delayed intervention, with subsequent policy adjustment to expedite intervention, and interim optimisation of medical management to reduce the incidence of recurrent stroke.
authors.affiliation: Section of Vascular Surgery, Imperial College London, UK mahim.qureshi@imperial.ac.uk.
authors.forename: Mahim I
authors.initials: MI
authors.lastname: Qureshi
authors.affiliation: Section of Vascular Surgery, Imperial College London, UK.
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology*; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Transient ischaemic attack; carotid atherosclerosis; carotid endarterectomy; carotid stent