Patient seen in TIA clinic local to area or stroke ward.

If Carotid Duplex shows >50-99% stenosis

Refer to Vascular team*: Monday-Friday 0800-1800, 0300 6133727; Vascular consultant on call via FPH switch or www.referapatient.org with as much relevant information as possible: symptoms onset, duration, L or R hand dominant.

*MDT discussion, must be quorate; modified MDT may take place to expedite treatment.

WPH/BNHH only

Review URGENTLY in hot clinic, TIA clinic or SAU within 48 hours of referral.

Secondary imaging requested and complete cross sectional imaging, if contraindicated, e.g., PPM, CT

If >50% stenosis on secondary imaging

Ensure the following have been carried out:

• Cross sectional imaging

• Bloods

• ECG

• Best medical therapy

  • Blood pressure control, cholesterol and antiplatelets

• Anaesthetic review

  • 1.Outpatient – HRAC via EPIC

  • 2.Inpatient via EPIC vascular referral or bleep 5639

• MDT discussion

Consider referral for CAS at St Georges if not suitable CEA (Stroke team to Stroke team referral).

Book to next available list

Aim to operate within 14 days of presentation.

If there is no space, admit patient and book to emergency list.