The value of urgent carotid surgery for crescendo transient ischemic attacks

Objective: This study audited operative risk in patients undergoing urgent carotid surgery for crescendo transient ischemic attacks (TIAs). Methods. Interrogation of the vascular unit database (January 1992 to July 2004) identified 42 patients operated on urgently for crescendo TIAs, which were defined as >= 3 TIAs within the preceding 7 days. Stroke, death, and any major cardiac events were analyzed. Results. Thirty-nine patients underwent conventional endarterectomy, and three underwent interposition vein bypass. Crescendo TIA patients had sustained a median of five TIAs (range, 3 to 20) in the 7 days before surgery. Three patients died or had a stroke after surgery, for a combined stroke/death rate of 7%. This compares with 2.4% in 1000 patients undergoing elective carotid endarterectomy in this unit during the same time period. The combined stroke/death/major cardiac event rate was 14% (n = 6). Conclusions. The combined risk of neurologic and cardiac complications after urgent carotid surgery for crescendo TLA, is higher than that expected after elective cases but is still acceptable considering the natural history of patients with unstable neurologic symptoms.