Rapid triage and secondary prevention in transient ischemic attack: a narrative review

Transient ischemic attack (TIA) requires urgent evaluation and treatment to prevent disabling stroke. This review provides an overview of TIA management including clinical presentation, risk stratification, diagnosis, site of care decisions, key diagnostic tests, imaging, acute treatment, hospitalization criteria, medical therapy for secondary prevention, and treatments targeting specific TIA mechanisms. TIA patients face up to a 20% 90-day recurrent stroke risk. Critical management components include prompt specialist assessment, brain/vascular imaging, cardiac monitoring, early antithrombotics, aggressive vascular risk factor control, patient education, and tailored secondary prevention strategies aimed at the underlying TIA mechanism. Expedited TIA protocols facilitate rapid intervention and are associated with reduced stroke rates compared to delayed management. With appropriate systems of care, lower-risk TIA patients can undergo outpatient evaluation. Higher-risk patients often warrant hospitalization for closer monitoring and access to advanced treatments if symptoms recur.

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