Imray, C. (Chris), Higman, D. and Tiivas, C. (2004) Timing of surgery for symptomatic carotid stenosis. The Lancet, Vol.363 (No.9420). pp. 1553-1554. doi:10.1016/S0140-6736(04)16162-X ISSN 0140-6736.

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Abstract

Sir
P M Rothwell and colleagues (Mar 20, p 915)1 present an important study. If the optimum timing of surgery for symptomatic carotid stenosis is 2 weeks after the patient's last symptoms, the implications for healthcare provision are enormous. To be able to offer the highest-risk patients early surgery, an attempt to stratify the risk of waiting needs to be made.
Transcranial doppler can be used to assess middle cerebral artery velocity and platelet microemboli. Immediately after a carotid-territory transient ischaemic attack (TIA) or stroke, there is a rise in microemboli in the middle cerebral artery, and patients who continue to embolise are at a greater risk of a further neurological event2. A high microembolic load after carotid endarterectomy is associated with early carotid thrombosis. Control of this load by means of intravenous transcranial doppler-directed antiplatelet agents reduces the risk of early postoperative stroke3. It is possible to influence the timing of carotid surgery in patients with recurrent or crescendo TIAs. Control of both emboli and symptoms with transcranial doppler-directed dextran allows these high-risk patients to undergo carotid surgery safely on the next elective list4.
Microemboli seem to be surrogate markers for future embolic events (TIAs or strokes) and the pharmacological efficacy of any therapeutic intervention can now rapidly and non-invasively be assessed. Transcranial doppler emboli detection could offer an approach to the management of patients both medically and surgically.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	The Lancet
Publisher:	Lancet Publishing Group
ISSN:	0140-6736
Official Date:	2004
Dates:	Date Event 2004 Published
Volume:	Vol.363
Number:	No.9420
Page Range:	pp. 1553-1554
DOI:	10.1016/S0140-6736(04)16162-X
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access

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