Safety of carotid revascularization within 48 hours of symptomatic presentation

In the last few years, there has been a gradual shift in the recommendations of carotid guidelines towards performance of carotid endarterectomy (CEA) earlier in patients with >70% carotid artery stenosis suffering an ipsilateral transient ischemic attack (TIA)/minor stroke episode. The "6-month" threshold in the early guidelines was subsequently replaced with a "14-day" target. More recently, an even earlier intervention (i.e. "within 48 hours") gains support as the optimal timing for the performance of CEA in patients with symptomatic carotid artery stenosis. The present article will summarize the evidence that led to this progressive reduction in the optimal timing for CEA in recently symptomatic carotid patients. It will also present the evidence supporting the safety of performing CEA within 48 hours of a TIA/minor stroke.