Fifty-three patients underwent emergency carotid thromboendarterectomy under surgical indications consisting of spontaneous cerebrovascular accident, stroke following carotid arteriography, stroke following successful carotid endarterectomy, and persistent transient ischemic attacks. Nearly 60% of the patients came to the operating room with some degree of neurologic deficit. There were six hospital deaths, five of whom were in the latter group. Based on immediate and late results of the operation, it is concluded that emergency carotid thromboendarterectomy is indicated (1) in patients with transient ischemic attacks who present with extremely severe narrowing of one or both internal carotid arteries, (2) when there is spontaneous stroke in selected patients (after angiography, disappearance of bruit) and, finally, (3) in patients who initially recover from carotid endarterectomy but go on to develop stroke as the result of thrombosis of the endarterectomized vessel.
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Hassan Najafi (1971) studied this question.