Management of transient cerebral ischemic attacks.

Transient ischemic attacks (TIAs) are brief reversible episodes of neurological dysfunction due to temporary focal cerebral ischemia. Angiography should be performed only when operation is indicated or when the diagnosis is in doubt. Surgical treatment is recommended when the patient is a good surgical risk, when the stenosis is more than 70 per cent in the appropriate vessel and in certain patients with less severe stenotic lesions that appear to be a probable source of emboli. Anticoagulant therapy is indicated when there are recurrent TIAs, when the patient is not a good surgical candidate and when no appropriate surgically remediable lesion is found by angiography. If there is any significant contraindication to anticoagulants they should not be given. Discontinuance of anticoagulant therapy when the patient has been symptom-free for six months is recommended. In the experience of the authors the TIA syndrome is more benign in its course than was originally suspected and a conservative approach to surgical and anticoagulant therapy is recommended.