Only four in 10 stroke patients receive potentially life-saving surgery to stop a recurrence within the recommended time frame, a report by the Royal College of Physicians and the Vascular Society found.

No hospital trust in Britain currently meets the two week NHS guideline target, drawn up by the National Institute for Health and Clinical Excellence (Nice).

Furthermore, one in ten hospital trusts don’t treat any stroke patients within that time.

Between October 2009 and September 2010, 6,079 mini-stroke patients underwent operations to clear the neck arteries – termed carotid surgery.

However, only 40 per cent were operated on within two weeks of symptoms first appearing. Some waited as long as two months.

Experts predict that if all were operated on within two weeks, as many as 200 strokes would be prevented for every 1,000 operations. That means up to 1,200 strokes could be prevented a year nationwide.

Slow referrals and lack of essential equipment and staff are causing most delays, found the report.

Carotid surgery is often undertaken after a person has suffered a ‘mini-stroke’, or transient ischemic attack (TIA), to stop a more devastating one happening.

Mini-strokes are caused by small pieces of debris on artery walls breaking free and travelling up into the brain where they become lodged, blocking the flow of blood. Frequently a larger piece breaks off days or weeks later.

Carotid surgery – or more precisely a carotid endartectomy – clears the walls of the two major neck arteries of build up, reducing the likelihood of another stroke.

Around 150,000 people have a stroke each year in Britain. Of those, one in six dies within a month, while half the survivors are left dependent on others for everyday support.

Joe Korner, of The Stroke Association, said: “Thousands of people could be saved from having a devastating stroke if they received urgent assessment and treatment for mini-strokes (TIAs).

“Despite some progress, not enough GPs are recognising the symptoms of mini-strokes and referring patients to specialist teams who can assess the need for preventative surgery.

“It’s incredibly disappointing that people still aren’t getting the treatment they deserve and that referrals aren’t happening quickly enough. Too often people don’t even go to their GP and the symptoms are ignored or simply put down to a ‘funny turn’.

“A mini-stroke is a warning sign of a possible future stroke and should always be treated as an emergency.”

The report highlighted startling variations across the country.

Of 126 hospital trusts that supplied data, no patient was operated on within two weeks of symptoms arising at 11 of them.

Only five managed to operate on more than seven in 10 within two weeks.

They were: North West London Hospitals NHS Trust (80 per cent), Leeds Teaching Hospitals NHS Trust (79), Guy’s and St Thomas’ NHS Foundation Trust (77), Aintree University Hospitals NHS Foundation Trust (76) and St George’s Healthcare NHS Trust (76).

The biggest reason for delay was failure to refer to a specialist stroke unit soon enough, accounting for 41 per cent of such cases.

In 17 per cent, there was limited availability of staff or operating theatre time, while in 13 per cent there was a lack of neck artery imaging equipment.

A quarter of delays were caused by patients not recognising they had suffered a mini-stroke.

David Mitchell, the vascular surgeon who chaired the Vascular Society audit, said: “Despite the good work by many clinicians, this study shows that we have a long way to go if we are to meet current NICE guidance.”

Underperforming trusts should “follow the best practice of others” he said.

Failure to meet Nice guidelines carries no financial penalty.

Since 2007 there have been even tougher guidelines in place. The National Stroke Strategy advises that carotid surgery should “ideally be performed within 48 hours of a TIA”. However, this too is just a recommendation.

The report found only two per cent of patients were being operated on within two days.

http://www.telegraph.co.uk/health/8586516/Faster-access-to-stroke-surgery-could-help-over-1000.html