Management of Patients with Transient Ischemic Attack Is Safe in an Outpatient Clinic Based on Rapid Diagnosis and Risk Stratification

Abstract

Background: Transient ischemic attack (TIA) patients are at high risk of short-term stroke, myocardial infarction and vascular death. Stroke risk is reduced by immediate treatment initialization. Stroke unit treatment is recommended for TIA patients. We established an outpatient TIA clinic to address the question whether outpatient evaluation of suspected TIA is safe. Methods: TIA workup included cerebral imaging, duplex sonography, transcranial Doppler screening for patent foramen ovale, electrocardiography, blood tests, ABCD₂ score and ankle-brachial index within one day. TIA patients received secondary prophylaxis immediately. TIA patients fulfilling predefined criteria for high early stroke risk (ABCD₂ score ≧4 points and TIA within 72 h, symptomatic stenosis, newly detected atrial fibrillation, recurrent TIA) were referred to the stroke unit. The remaining patients were discharged home. 90-day telephone follow-up was obtained. Results: 123 consecutive patients with suspected TIA (53 male, age 59 ± 17.2 years) were prospectively evaluated. TIA or minor stroke was diagnosed in 69 (56%), and TIA mimics in 54 (44%) patients. Median time from symptom onset to presentation was 48 h (1 h to 3 months). Patients with TIA/minor stroke presented significantly more frequently with ABCD₂ score ≧4 points (p = 0.021). Twelve patients (9.8%) were admitted to the stroke unit. There were 2 strokes during follow-up. The stroke rate was 1.6% within all patients, and 2.9% within the subgroup of patients with TIA/minor stroke, compared to 5.7% predicted by the ABCD₂ score. Other vascular end points were not found. Conclusion: Based on risk stratification, outpatient evaluation of TIA is safe. TIA mimics are frequent.