Carotid endarterectomy may substantially reduce the risk for a major stroke in certain patients if done sufficiently soon after a transient ischemic attack, according to an article in the March 20th issue of the Lancet.

Peter Rothwell and his British colleagues analyzed pooled data from two trials (the European Carotid Surgery Trial and North American Symptomatic Carotid Endarterectomy Trial, total of roughly 5,900 participants) to assess the risk of stroke without surgery, the risk of stroke and death due to surgery, and the overall benefit from surgery.

Benefit from endarterectomy was greatest in men, patients aged 75 years or older, and those randomized to treatment within 2 weeks of their transient ischemic attack; benefit (in terms of decreased risk for stroke) fell rapidly with increasing delay.

Rothwell commented, "Benefit is particularly dependent on the delay to surgery after the presenting event. Ideally, the procedure should be done within 2 weeks. Unfortunately, in the UK and elsewhere, the operation is often not done until several months after the event - even if the patient seeks medical attention immediately after their warning stroke. Benefit from surgery is very much reduced at this time, and many patients who would have benefited have their major stroke whilst waiting for surgery."

The need for urgent investigation and treatment stems from the high risk of major stroke in the first few days and weeks after a transient ischemic attack. Rothwell added, "There is therefore a need to educate the public about the symptoms of warning strokes and transient ischemic attacks so that people seek medical attention immediately. The importance of this latest study is that it shows that many more strokes can be prevented if treatment is initiated early. The problem currently in the UK, and in many other countries, is that we are just not set up to investigate and treat patients sufficiently quickly."