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Risk Stratification and Management of TIA and Minor Stroke

  • Alexandra D. MuccilliEmail author
  • Shelagh B. Coutts
  • Andrew M. Demchuk
  • Alexandre Y. Poppe
Chapter

Abstract

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.

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Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Alexandra D. Muccilli
    • 1
    Email author
  • Shelagh B. Coutts
    • 2
  • Andrew M. Demchuk
    • 2
  • Alexandre Y. Poppe
    • 1
  1. 1.Department of NeurosciencesCentre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, Université de MontréalMontrealCanada
  2. 2.Department of Clinical NeurosciencesFoothills Medical Centre, University of CalgaryCalgaryCanada

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