Urgent need for secondary stroke prevention after transient ischemic attack

Abstract

Objective: To review symptom awareness, diagnostic techniques, and therapeutic interventions for the recognition and treatment of transient ischemic attack (TIA) and to discuss secondary stroke prevention after TIA.

Data sources: Published information related to recognition and treatment of TIA and the prevention of a secondary cerebrovascular event after TIA.

Data synthesis: Literature review reveals high risk for an early, secondary cerebrovascular event after TIA. Historically, TIA was not treated urgently; today, it is understood that TIA is a sign of a serious condition and may be an indication of impending disability and death. Prompt initiation of treatment may significantly reduce morbidity and mortality. However, many factors, such as low public awareness of symptoms, lack of urgency, or unavailability of brain imaging devices, are responsible for treatment delay. Delay between symptom onset and symptom diagnosis may preclude the use of tissue-plasminogen activator, which must be administered within a three-hour window from time of onset. Other therapeutic interventions for secondary stroke prevention after a TIA include the early use of antiplatelet agents (aspirin, clopidogrel, dipyridamole), and may involve procedures such as carotid endarterectomy and stenting. Risk reduction may also be achieved by treating hypertension and hypercholesterolemia.

Conclusion: TIA and stroke must be recognized and treated urgently. Through public education, readily available information, access to diagnostic imaging devices, and aggressive preventive strategies and treatments, the frequency and severity of secondary cerebrovascular events, as well as the economic burden of secondary stroke, could be substantially reduced.