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The patient recovered in 3 months as most patients with major cranial nerve injuries do.16 Two (1.4%) patients presented speech slurring due to deviation of the tongue resulting from hypoglossal nerve stretching. At 1-month control visit, one had recovered fully, while the other still had some difficulties with speech and was referred to neurological evaluation for rehabilitation. Taken together, there was a 2.8% perioperative combined stroke and/or death risk, 2.1% risk of transient cranial nerve damage and 5.5% risk of wound complications. The median postoperative LOS was 2 days. In 48 patients (33%), LOS exceeded 2 days, including eight patients who had postoperative complications as described above. The most common reason for extended stay in the ward was hypertension alone (n?=?13, 9%) or combined with headache (n?=?3, [http://www.selleckchem.com/products/a-1331852.html A-1331852 mw] 2%). All these patients [http://en.wikipedia.org/wiki/GUCY1B3 GUCY1B3] were successfully treated with anti-hypertensive medication. Transcranial Doppler (TCD) was performed on patients experiencing headache. None of these patients developed hyperperfusion syndrome. If pre- or postoperative stroke compromised home care (n?=?29), referrals were made either to a neurological ward or to the primary care centre. These patients' median hospital stay was 3 days (0�C11). At discharge, 79% (n?=?116) went home, 7% (n?=?10) to a HUCH neurological ward, 8% (n?=?11) to a secondary neurological ward and 6% (n?=?8) to a primary care centre ward. Effectiveness analysis was made by dividing patients into subgroups by sex, degree of stenosis and delay (Fig.?4). Sixty-five percent were operated with a good benefit expectation (NNT?[http://www.selleckchem.com/products/eai045.html VEGFR inhibitor] when there was no theoretical benefit for the patient due to prolonged SKT. Surgery for symptomatic carotid stenosis is highly beneficial in stroke prevention.17?and?18 The benefit is associated with symptoms, gender, age, degree and nature of the stenosis, delay from symptom to surgery as well as postoperative complication rate. Delay from symptom to surgery has been proven to be associated strongly with the effectiveness of CEA in stroke prevention.6?and?7 The benefit decreases rapidly after 2 weeks from the symptom.12?and?13 In the previous report, we found that the delay in carotid surgery was far too long in our hospital 3 years ago (Vikatmaa et?al.).13 After these concerning results, we made an effort to decrease the delay. Rather, simple changes made in HUCH in 2009 have shortened the delay from symptom to surgery significantly from the median of 49 to 19 days. Especially the surgical delay from 25 to 8 days can be regarded as a substantial improvement. This was expected, since the main focus of the intervention was to decrease the in-hospital delay, that is, the door-to-knife time (DKT). No attempt was made to improve the public awareness.