Fewer than half of the people in the UK who are at high risk of having a stroke are benefiting from an operation that could improve blood flow in the neck, a report in the BMJ has noted.

UK vascular surgeons carry out 4,500 carotid endarterectomies a year but an estimated 10,000 patients could benefit from the operation, according to a recent audit. The number of carotid endarterectomies per head of population in the UK is the lowest in the developed world.

Surgeons have called for an urgent review to ensure that patients who are at high risk of a stroke are fast-tracked to hospital.

NICE guidelines say that patients with symptoms of stroke or transient ischaemic attack (TIA) should have surgery within two weeks, while the National Stroke Strategy recommends surgery within 48 hours. However, the audit shows that only 3% of these patients have surgery within 48 hours, and only a third within 14 days - the average wait being 28 days.

The audit found that 18% of delays were due to patients not presenting, 40% to lack of GP referral, 18% to lack of hospital staff or theatre time, and 9% to lack of imaging equipment.

Ross Naylor, consultant vascular surgeon at Leicester Royal Infirmary and a member of the audit steering group, said that achieving the goal of surgery within 48 hours of symptoms depended on "multidisciplinary team working".

He added: "Healthcare purchasers and providers must stop tolerating delays in the system and address the problems. Strokes and TIAs are emergencies and must be treated as such."

David Mitchell, chairman of the Vascular Society of Great Britain, called for the creation of "a comprehensive service fit for purpose for urgent carotid surgery" through centralisation of in-patient vascular services.