Recent advances in the management of transient ischemic attacks

Abstract

Significant advances in our understanding of transient ischemic attack (TIA) have taken place since it was first recognized as a major risk factor for stroke during the late 1950's. Recently, numerous studies have consistently shown that patients who have experienced a TIA constitute a heterogeneous population, with multiple causative factors as well as an average 5–10% risk of suffering a stroke during the 30 days that follow the index event. These two attributes have driven the most important changes in the management of TIA patients over the last decade, with particular attention paid to effective stroke risk stratification, efficient and comprehensive diagnostic assessment, and a sound therapeutic approach, destined to reduce the risk of subsequent ischemic stroke. This review is an outline of these changes, including a discussion of their advantages and disadvantages, and references to how new trends are likely to influence the future care of these patients.

Management of Acute Retinal Ischemia

“…It is well established that TIAs offer an opportunity to initiate treatment that can forestall the onset of permanent disability. 4,27 Major advances in the urgent evaluation of TIA patients and in secondary prevention strategies have resulted in a dramatic decrease in the risk for major stroke after a TIA or minor stroke. 27e30 Previous studies conducted before the early 2000s estimated the risk of stroke and acute coronary syndromes between 12% and 20% during the first 3 months after a TIA or a minor stroke, with a large proportion of these strokes occurring very early after the first events.…”

“…Strokes and TIAs are on a spectrum of serious conditions involving brain and eye ischemia, just as angina and acute myocardial infarction are part of the continuum of acute coronary syndromes. 4 It is therefore logical to combine vascular TMVL, BRAO, and CRAO as "acute retinal arterial ischemia" and to propose the same systematic management for these 3 entities. Although their respective visual outcomes are different, their overall significance and their systemic and neurologic implications are similar.…”

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

“…Whilst these results have shed some light on the association between TIA and stroke, they also have had several limitations that must be acknowledged. First, several of the studies were conducted more than a decade ago [3][4][5][6] and, since the management of TIA has undergone several advances in recent years [15], their findings may not accurately depict the current TIA-stroke relationship.…”

“…Whilst these results have shed some light on the association between TIA and stroke, they also have had several limitations that must be acknowledged. First, several of the studies were conducted more than a decade ago and, since the management of TIA has undergone several advances in recent years , their findings may not accurately depict the current TIA–stroke relationship. Secondly, most of the recent studies followed participants for 5 years or less , so the long‐term risk of stroke and associated predictors in patients with a history of TIA remains largely unknown.…”

The changing face of transient ischaemic attacks

“…The success of a TIA clinic depends on several factors including fast track access (i.e. appointments made within 24 hours for all patients) [48][49][50][51][52] , assessment by a specialist interested in TIA/stroke [53][54][55][56] , rapid access to diagnostic investigations, multidisciplinary care 21,57 and availability of educational programs 57,58 . Importantly, a TIA clinic is a low-cost effective intervention that can be deployed in any centre in Sri Lanka providing specialist care.…”