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In conjunction with the regional stroke unit, the St George’s Vascular Institute offers a comprehensive service for patients with carotid atherosclerosis. Indications for surgical intervention are defined for both asymptomatic and symptomatic patients with a stenosis greater than 70%. Outpatients with suspected carotid atherosclerosis are assessed in a one-stop clinic with access to immediate duplex scanning. All patients who have symptomatic carotid stenosis are subject to multidisciplinary discussion, which includes stroke physicians, neurologists, vascular surgeons and interventional radiologists. In current practice the timing of carotid surgery is crucial following a neurological event.

Contemporary studies have demonstrated that patients derive maximum benefit from carotid revascularisation if surgery is performed shortly after the onset of symptoms. In the St George’s Unit, surgery is planned within 48h of admission with a stroke or TIA, if clinical condition permits.