Definition and evaluation of transient ischemic attack

A scientific statement for healthcare professionals from the American heart association/American stroke association stroke council; council on cardiovascular surgery and anesthesia; council on cardiovascular radiology and intervention; council on cardiovascular nursing; and the interdisciplinary council on peripheral vascular disease

J. Donald Easton, Jeffrey L. Saver, Gregory W. Albers, Mark J. Alberts, Seemant Chaturvedi, Edward Feldmann, Thomas S. Hatsukami, Randall T. Higashida, S. Claiborne Johnston, Chelsea S. Kidwell, Helmi L. Lutsep, Elaine Miller, Ralph L Sacco

Research output: Contribution to journalArticle

984 Citations (Scopus)

Abstract

This scientific statement is intended for use by physicians and allied health personnel caring for patients with transient ischemic attacks. Formal evidence review included a structured literature search of Medline from 1990 to June 2007 and data synthesis employing evidence tables, meta-analyses, and pooled analysis of individual patient-level data. The review supported endorsement of the following, tissue-based definition of transient ischemic attack (TIA): a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk of early stroke, and their risk may be stratified by clinical scale, vessel imaging, and diffusion magnetic resonance imaging. Diagnostic recommendations include: TIA patients should undergo neuroimaging evaluation within 24 hours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD score = 3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis.

Original languageEnglish
Pages (from-to)2276-2293
Number of pages18
JournalStroke
Volume40
Issue number6
DOIs
StatePublished - Jun 1 2009
Externally publishedYes

Fingerprint

Cardiovascular Nursing
American Heart Association
Peripheral Vascular Diseases
Transient Ischemic Attack
Radiology
Anesthesia
Stroke
Delivery of Health Care
Diffusion Magnetic Resonance Imaging
Allied Health Personnel
Hematologic Tests
Neuroimaging
Infarction
Blood Vessels
Echocardiography
Meta-Analysis
Spinal Cord
Electrocardiography
Outpatients
Ischemia

Keywords

  • Acute cerebrovascular syndromes
  • Acute stroke syndromes
  • AHA scientific statements
  • Brain
  • Brain ischemia
  • Cerebral ischemia
  • Ischemia
  • Stroke
  • Transient ischemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Definition and evaluation of transient ischemic attack : A scientific statement for healthcare professionals from the American heart association/American stroke association stroke council; council on cardiovascular surgery and anesthesia; council on cardiovascular radiology and intervention; council on cardiovascular nursing; and the interdisciplinary council on peripheral vascular disease. / Easton, J. Donald; Saver, Jeffrey L.; Albers, Gregory W.; Alberts, Mark J.; Chaturvedi, Seemant; Feldmann, Edward; Hatsukami, Thomas S.; Higashida, Randall T.; Johnston, S. Claiborne; Kidwell, Chelsea S.; Lutsep, Helmi L.; Miller, Elaine; Sacco, Ralph L.

In: Stroke, Vol. 40, No. 6, 01.06.2009, p. 2276-2293.

Research output: Contribution to journalArticle

@article{65ebc88d25b84c8d9e1badca243da947,
title = "Definition and evaluation of transient ischemic attack: A scientific statement for healthcare professionals from the American heart association/American stroke association stroke council; council on cardiovascular surgery and anesthesia; council on cardiovascular radiology and intervention; council on cardiovascular nursing; and the interdisciplinary council on peripheral vascular disease",
abstract = "This scientific statement is intended for use by physicians and allied health personnel caring for patients with transient ischemic attacks. Formal evidence review included a structured literature search of Medline from 1990 to June 2007 and data synthesis employing evidence tables, meta-analyses, and pooled analysis of individual patient-level data. The review supported endorsement of the following, tissue-based definition of transient ischemic attack (TIA): a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk of early stroke, and their risk may be stratified by clinical scale, vessel imaging, and diffusion magnetic resonance imaging. Diagnostic recommendations include: TIA patients should undergo neuroimaging evaluation within 24 hours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD score = 3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis.",
keywords = "Acute cerebrovascular syndromes, Acute stroke syndromes, AHA scientific statements, Brain, Brain ischemia, Cerebral ischemia, Ischemia, Stroke, Transient ischemic attack",
author = "Easton, {J. Donald} and Saver, {Jeffrey L.} and Albers, {Gregory W.} and Alberts, {Mark J.} and Seemant Chaturvedi and Edward Feldmann and Hatsukami, {Thomas S.} and Higashida, {Randall T.} and Johnston, {S. Claiborne} and Kidwell, {Chelsea S.} and Lutsep, {Helmi L.} and Elaine Miller and Sacco, {Ralph L}",
year = "2009",
month = "6",
day = "1",
doi = "10.1161/STROKEAHA.108.192218",
language = "English",
volume = "40",
pages = "2276--2293",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Definition and evaluation of transient ischemic attack

T2 - A scientific statement for healthcare professionals from the American heart association/American stroke association stroke council; council on cardiovascular surgery and anesthesia; council on cardiovascular radiology and intervention; council on cardiovascular nursing; and the interdisciplinary council on peripheral vascular disease

AU - Easton, J. Donald

AU - Saver, Jeffrey L.

AU - Albers, Gregory W.

AU - Alberts, Mark J.

AU - Chaturvedi, Seemant

AU - Feldmann, Edward

AU - Hatsukami, Thomas S.

AU - Higashida, Randall T.

AU - Johnston, S. Claiborne

AU - Kidwell, Chelsea S.

AU - Lutsep, Helmi L.

AU - Miller, Elaine

AU - Sacco, Ralph L

PY - 2009/6/1

Y1 - 2009/6/1

N2 - This scientific statement is intended for use by physicians and allied health personnel caring for patients with transient ischemic attacks. Formal evidence review included a structured literature search of Medline from 1990 to June 2007 and data synthesis employing evidence tables, meta-analyses, and pooled analysis of individual patient-level data. The review supported endorsement of the following, tissue-based definition of transient ischemic attack (TIA): a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk of early stroke, and their risk may be stratified by clinical scale, vessel imaging, and diffusion magnetic resonance imaging. Diagnostic recommendations include: TIA patients should undergo neuroimaging evaluation within 24 hours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD score = 3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis.

AB - This scientific statement is intended for use by physicians and allied health personnel caring for patients with transient ischemic attacks. Formal evidence review included a structured literature search of Medline from 1990 to June 2007 and data synthesis employing evidence tables, meta-analyses, and pooled analysis of individual patient-level data. The review supported endorsement of the following, tissue-based definition of transient ischemic attack (TIA): a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk of early stroke, and their risk may be stratified by clinical scale, vessel imaging, and diffusion magnetic resonance imaging. Diagnostic recommendations include: TIA patients should undergo neuroimaging evaluation within 24 hours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD score = 3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis.

KW - Acute cerebrovascular syndromes

KW - Acute stroke syndromes

KW - AHA scientific statements

KW - Brain

KW - Brain ischemia

KW - Cerebral ischemia

KW - Ischemia

KW - Stroke

KW - Transient ischemic attack

UR - http://www.scopus.com/inward/record.url?scp=66849099871&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66849099871&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.108.192218

DO - 10.1161/STROKEAHA.108.192218

M3 - Article

VL - 40

SP - 2276

EP - 2293

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -