Abstract
A brief report of 3 patients with acute stroke undergoing urgent Carotid Endarterectomy under local-regional anaesthesia are presented. In cases with acute or evolving ischaemic stroke, a narrow time window exists between neuronal cell ischaemia and cell death. The stroke outcome is largely dependent on management strategies during this time interval. Treatments may include anti-thrombotic and reperfusion therapy and medication for neuronal protection [1]. Reperfusion of existing ischaemic areas may either be accomplished through thrombolysis with drugs such as recombinant tissue plasminogen activator (rTPA)[2] or carotid endarterectomy (CEA) where there is significant ipsilateral carotid stenosis. For about a decade now, it has been established that CEA significantly reduces the stroke risk in patients with symptomatic carotid stenosis [3,4]. However, controversy has surrounded the use of urgent CEA for acute cerebral ishaemia [5], the major fear being conversion of cerebral ischaemia into haemorrhage with worsening of the neurologic state. Three patients undergoing urgent CEA under local anaesthesia are presented. Two had stroke in evolution and one had a crescendo transient ischaemic attack. Fresh clot was found at the site of occlusion in 2 cases and all 3 patients had a full recovery.
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