[Indications for urgent carotid reconstruction]

Diagnostic methods and indications for carotid surgery must be coordinated with the individual carotid-related stroke risk. The indication for urgent carotid reconstruction within a few days after the initial event should always be evaluated when a clinical and/or morphological unstable and therefore risky carotid lesion is present and the 30-day stroke risk without surgery is > 5%. Patients with high-grade symptomatic carotid stenoses fulfill these criteria as do patients with recurrent carotid-related TIA, patients with hemipheric TIA, patients with symptomatic carotid stenosis and contralateral carotid occlusion and patients after a non-disabling carotid-related stroke. The clinical significance of sonographic carotid plaque criteria and intracranial emboli detected by TCD must be further evaluated in prospective studies.