The use of neurovascular imaging for triaging TIA and minor stroke: implications for therapy.

Nondisabling cerebrovascular events (minor stroke or transient ischemic attack) are not benign; a significant proportion of these patients will suffer a new disabling stroke or develop stroke progression in hospital, resulting in dependence or death. With the exception of the modest benefits of aspirin, there are currently no effective acute medical therapies to prevent early progression or recurrence in such patients. Early carotid revascularization appears to be the most efficacious treatment available for patients with symptomatic (> 50%) internal carotid artery stenosis. More acute treatment and acute prevention trials are needed. MRI, CT bolus techniques, and transcranial Doppler emboli detection represent tools for detection of patients at high risk for deterioration and should be incorporated into the development of effective therapies by targeting the most appropriate patients for intervention.