At the International Society for Vascular Surgery (ISET) in Hollywood, USA, in late January 2009, Dr Anthony J Comerota from the University of Michigan suggested that patients with symptomatic carotid stenosis should undergo surgery as early as possible to prevent recurrent strokes. He believes that carotid endarterectomy should be performed within two weeks of the first transient ischemic attack or non-disabling stroke to prevent re-dislodgement of atherosclerotic plaque in the carotid artery leading to a recurrent stroke. The traditional view is that carotid endarterectomy should be performed 4-6 weeks after the stroke event and only after the intracranial infarctive lesion has stabilized. However, it has been found that many patients are susceptible to a recurrent stroke event within a short period of time after the initial ischemic stroke event. In particular, Dr. Comerota emphasized that although there is no evidence that performing carotid endarterectomy early in stroke may increase complications, there is concern that early endarterectomy may lead to exacerbation of stroke or even intracranial hemorrhage. However, the literature reports that early carotid endarterectomy does not increase complication rates compared with late carotid endarterectomy. For example, the clinical data of Sbargia E et al (Sbargia E et al, Eur J Vasc Endovasc Surg 2006;32:22) showed that only 3.1% of 96 patients with ischemic stroke had worsening neurological symptoms after early carotid endarterectomy, and 9% had stable neurological symptoms with no change. In contrast, 47% of the patients had significant improvement in neurological function, no new foci of infarction on CT scan and no intracranial hemorrhage. Dr. Comerota strongly recommends early carotid endarterectomy for patients with symptomatic carotid stenosis, as 69% of strokes recur within 4 weeks.