Objective: The optimal timing of carotid endarterectomy (CEA) after symptomatic carotid stenosis (SCS) is controversial. The purpose of this study was to analyse the 30 day outcome after introduction of a subacute CEA program looking at the incidence of recurrent transient ischemic attacks (TIA), minor/major stroke and death in this group of patients.

Methods: This is a prospective, single center, ‘direct face-to-face’ consecutive study of delays to CEA and 30-day outcomes in group with SCS, who underwent CEA between 1 October 2010 and 01 Oct. 2012 after the creation of a rapid access carotid service in our region ( 15% of Danish population). Disability was defined as a score of 3 to 6 on the modified Rankin scale at 14 days. The subacute CEA was defined as CEA ≥ 48 hours to ≤ 30 days after last ictus.

Results: Of a total of 4975 patients with TIA, stroke and AF_X , 115 symptomatic patients underwent CEA, 40% within 14 days of the index event and 99% within 14 days of referral. The median delay with exclusion of weekends was 15 days (95% CI 3-85) from the ictus to CEA and 4 days (95% CI 2-6) from referral. 53% (95% CI 49-60%) of cases had long delays (> 5 days) to duplex ultra-sound. The overall NR from index event to CEA in SCS patients was statistically significantly lower n=3 (95% CI 2-4%) after urgent BMT against NR up to 90 days before the first contact to stroke clinics n=30 (95% CI 25-35) %, (P<0.0001). There were no perioperative strokes, myocardia infarction (MI) or deaths. In patients undergoing CEA, there has been no significant difference in outcome between 81 early CEA (< 30 days) and 34 delayed (>30 days) CEA.

Conclusion: An expedited CEA in subacute period (> 48 h to < 30 days) after index event in SCS patients is safe. A more rapid or emergency (≤48 h) CEA policy in our region could not be justified. Our study suggests that more education of TIA/AF_X symptoms, more rapid referral from family doctors and eye specialists to stroke clinics and more fast-track duplex ultrasound in stroke clinics could dramatically reduce the waiting time from symptom to CEA.