Minor Stroke and TIA Outcomes Show Big Improvement Over Past Decade

By Joe Elia

Edited by Richard Saitz, MD, MPH, FACP, FASAM

The use of urgent specialized evaluation of patients with minor stroke or transient ischemic attack (TIA) has greatly reduced subsequent risk, according to an industry-funded study in the New England Journal of Medicine.

TIAregistry.org researchers prospectively followed some 4600 such patients in an international multicenter study. Patients were urgently evaluated by stroke specialists and received standard-of-care treatment — anticoagulation, antihypertensives, and large-vessel revascularization as needed.

The primary outcome was the composite of stroke, acute coronary syndrome, or cardiovascular death by 1 year. Stroke occurred in 5.1% of patients, and the composite in 6.2%. Factors associated with greater risk included multiple infarctions found on brain imaging, a higher ABCD² score (i.e., age, blood pressure, clinical findings, duration of symptoms, diabetes), and large-artery atherosclerosis.

Editorialists note that the risks found in this series of patients receiving urgent care and management by stroke specialists "were at least 50% lower than those reported in previous studies."