Cerebrovascular Transient Ischemic Attack

Overall incidence in USA: Approximately 1.1 per 1000.

Risk related to demographic factors: Age, gender, and race.

Estimated prevalence of TIA in men is 2.7% versus 1.6% in women ages 65–69 y, and 3.6% in men versus 4.1% in women ages 75–79 y. The overall prevalence is estimated to be 0.4% among adults 45–64 y.

African Americans and Hispanics at higher risk than Caucasians.

Pts with Hx of TIAs at increased risk of postop stroke.

Risk of periop stroke increased in pts with medical Hx of cerebral vascular disease, peripheral vascular disease, hypertension, diabetes, chronic renal insufficiency, COPD, and atrial fibrillation.

Pts with CAD for CABG have a high incidence of carotid stenosis (50% with some; 20% with stenosis >50%).

Likewise, pts with carotid stenosis have high incidence of CAD (over 50%).

Risk of periop stroke increased in pts with planned surgery: CABG (3–6%), vascular (1%).

Pts with Hx of stroke 9 mo or less ago at increased risk of major adverse cardiac events and mortality after elective, noncardiac surgery (even low- and intermediate-risk surgeries).

Crescendo TIAs

Duration of symptoms >1 h

Symptomatic or critical internal carotid artery stenosis

Known cardiac source of embolus, such as atrial fibrillation

Known hypercoagulable state

TIA: Transient episode of neuro dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. The end is biologic (tissue injury) rather than arbitrary (24 h).

Risk of hospitalization for major cardiac event after TIA is 2.6% for first 90 days.

ABCDD score for assessing risk of stroke after TIA.

• A = Age (> 60 y = 1 point)

• B = Blood pressure elevation when first assessed after TIA (systolic ≥140 mm Hg or diastolic ≥90 mm Hg = 1 point)

• C = Clinical features (unilateral weakness = 2 points; isolated speech disturbance = 1 point; other = 0 points)

• D = Duration of TIA symptoms (≥60 min = 2 points; 10 to 59 min = 1 point; <10 min = 0 points)

• Diabetes (present = 1 point)

Score interpretation:

• Score 6 to 7: High 2-day stroke risk (8.1%)

• Score 4 to 5: Moderate 2-day stroke risk (4.1%)

• Score 0 to 3: Low 2-day stroke risk (1%)