Surgery for acute carotid occlusion. Therapy in search of predictability

Carotid thromboendarterectomy is rarely performed in the face of an acute, apparently nontransient neurologic deficit. However, clinical improvement may follow timely surgery. Because efficacy and safety remain unpredictable, operative therapy is denied to many patients who might benefit. We reviewed six illustrative cases and the clinical and experimental rationale for surgery in patients with an acute carotid occlusive neurologic deficit in hopes of stimulating renewed interest in refining criteria for selection of operative candidates.