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(Stroke. 2006;37:1137.)
© 2006 American Heart Association, Inc.

Controversies in Stroke

Patients With Transient Ischemic Attack or Minor Stroke Should Be Admitted to Hospital

For

Geoffrey A. Donnan, MD, FRACP; Stephen M. Davis, MD, FRACP, Section Editors:; Michael D. Hill, MD, MSc, FRCPC David J. Gladstone, MD, FRCPC

From the University of Calgary, Department of Clinical Neuroscience, Calgary, Alberta, Canada; and University of Toronto, Division of Neurology, Department of Medicine, and Regional Stroke Centre, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada.

Correspondence to Michael D. Hill, University of Calgary, Department of Clinical Neuroscience, Room 1242A, Foothills Medical Centre, 1403 29th St NW, Calgary, Alberta, T2N 2T9, Canada. E-mail michael.hill@calgaryhealthregion.ca

Key Words: transient ischemic attack

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Transient ischemic attacks (TIAs), like other vascular diseases, whether acute limb ischemia or acute coronary syndromes, are high-risk, unstable conditions. TIA heralds a relatively high risk of stroke, variably estimated to range between 10% and 20% in the ensuing 90 days.^1–4 This has been known for several decades.^5–8 What is new are reports that show that at least half of the risk of early stroke accrues in the first 2 days after TIA. Necessarily then, any protective strategy needs to be implemented rapidly.

It is surprising that for a condition as common and serious as TIA, there remains so much variability in acute management. Whereas in some institutions, TIA patients are admitted routinely, in other jurisdictions, TIA patients are frequently discharged from the emergency department with suboptimal management, and many discharged TIA patients are unlikely to obtain adequate evaluation or treatment on an outpatient basis within 30 days.⁴

What Are the Potential Benefits of Hospitalization?

Although the value of inpatient stroke units is well established, little is known about the value of acute observation and investigation units for patients with TIA or minor stroke. Some potential benefits of a short-stay hospital admission include: (1) expedited diagnostic evaluation; (2) monitoring of fluctuating patients with ready access to thrombolysis if they deteriorate; (3) facilitation of early carotid revascularization; and (4) greater opportunity for risk factor modification.⁹

What Evidence Is There That We Should Apply Stroke Prevention Strategies Rapidly?

The benefit of carotid endarterectomy for stroke prevention in symptomatic patients is time dependent. Pooled analysis of the European Carotid Surgery Trial and North American Symptomatic Carotid Endarterectomy Trial studies has demonstrated that . . . [Full Text of this Article]

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