Early carotid surgery has been suggested to be an important cause of perioperative deterioration due to secondary haemorrhage into a recent brain infarction. It has also been suggested that the existence of preoperative neurological deficits may worsen the prognosis of surgical treatment in carotid disease. Neither of these observations could be confirmed; severe perioperative complications (5%) in this study of carotid endarterectomy were strongly related to the degree of carotid stenosis. This aspect of carotid surgery has not been previously studied. Even though technical difficulties may play an exaggerated role in a training hospital system, it is nevertheless necessary to assess the impact of surgical procedures of different extent when the "acceptable risk" for carotid surgery is calculated.
