From the Guidelines
The recurrence rate of Transient Ischemic Attack (TIA) is as high as 13% in the first 90 days after the initial event, and up to 30% within 5 years. This highlights the importance of prompt evaluation and treatment following a TIA to prevent progression to a completed stroke. According to the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1, the risk of recurrence is highest in the first week after the initial event.
Key factors that increase the risk of recurrence include:
- High-grade stenosis of the carotid artery
- Symptom duration over 10 minutes
- Speech impairment
- Motor weakness The ABCD2 score can help stratify patients' short-term stroke risk after TIA.
To reduce recurrence rates, patients who have experienced a TIA should receive immediate medical attention and preventive therapy, including:
- Antiplatelet medications
- Statins
- Blood pressure control
- Lifestyle modifications As noted in the guideline, early recognition of TIA, identification of patients at risk, and risk factor modification are important stroke prevention measures 1.
From the Research
Recurrence Rate of Transient Ischemic Attack (TIA)
- The recurrence rate of TIA varies across studies, with one study finding that 72% of patients had more than one TIA 2.
- Another study reported that 21% of patients had recurrent TIA 3.
- The risk of recurrent stroke after TIA is significant, with one study finding a 10.3% risk of recurrent stroke within 90 days 4.
- Early treatment of TIA can reduce the risk of recurrent stroke, with one study finding an 80% reduction in risk with urgent treatment 4.
Factors Associated with Recurrence
- Capsular warning syndrome and large artery atherosclerosis are associated with early recurrent TIA 3.
- TIAs with lesion, dysarthria, and leukoaraiosis are independent predictors of stroke incidence after early recurrent TIA 3.
- The ABCD3 score can predict the risk of stroke recurrence, with a score >6 indicating a higher risk 3.
Treatment and Outcome
- Intensive antiplatelet therapy does not reduce the incidence and severity of recurrent stroke or TIA, but increases the risk of major bleeding 5.
- Aspirin, aspirin plus extended-release dipyridamole, and clopidogrel are commonly used treatments to reduce the risk of recurrent stroke 6.
- Early initiation of existing treatments after TIA or minor stroke can reduce the risk of early recurrent stroke 4.