A 70-year-old man presents with a carotid duplex showing a 75% stenosis of the right internal carotid artery following a transient ischaemic attack (TIA) 3 days ago. He has fully recovered neurologically. The NASCET criteria define symptomatic carotid stenosis ≥70% as benefiting from carotid endarterectomy (CEA). When should CEA be performed?
- A Within 2 weeks of the TIA for maximum stroke risk reduction ✓
- B After 3 months of antiplatelet therapy and re-imaging
- C Only if a second TIA occurs
- D Defer for 6 months and repeat duplex to assess plaque stability
Correct answer: A. Within 2 weeks of the TIA for maximum stroke risk reduction
Explanation
NICE and ESVS guidelines recommend carotid endarterectomy within 48 hours (ideally) or within 2 weeks of a TIA or non-disabling stroke in patients with 70–99% symptomatic stenosis (NASCET criteria). The stroke risk is highest in the first 2 weeks after TIA, and early CEA substantially reduces this risk; delays beyond 2 weeks markedly diminish the benefit.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.