Risk Stratification and Management of TIA and Minor Stroke

Together, transient ischemic attack (TIA) and minor stroke represent the largest group of cerebrovascular events, with one study estimating that over 80% of all stroke patients fall into this category [1]. With the advent of reperfusion therapies for acute ischemic stroke, systems of care have been streamlined such that patients with disabling or non-disabling deficits often present and are assessed very quickly after the onset of symptoms. Despite this, those with non-disabling deficits often fall into a therapeutic void since they are not considered eligible for thrombolysis or thrombectomy. This is particularly tragic since among patients considered too mild for thrombolytic therapy, up to one-third end up dead or dependent on being discharged from hospital [2, 3]. Furthermore, 15–30% of disabling strokes are heralded by non-disabling stroke or TIA, usually within the preceding 7 days [4]. Many studies have also demonstrated that after TIA or minor stroke, there is an approximately 10% risk of subsequent stroke within 90 days [5–13]. Functional disability may also affect about 15% of patients with TIA and minor stroke even in the absence of stroke recurrence [14]. Finally, as markers of vascular disease, TIAs predict an increased risk for all cardiovascular events and death in the longer term [5, 8]. Patients with mild cerebral ischemia represent an ideal target for therapy since they have a significant amount of tissue and function to safeguard in the face of an elevated early risk of major stroke.