Johnston SC et al. (2006) National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol 60: 301–313

Transient ischemic attack (TIA) is often a precursor to major ischemic stroke, and appropriate management of the condition is, therefore, highly important. Currently, considerable variation exists in how the condition is managed, and the majority of published treatment guidelines are several years old. Newly updated evidence-based, unbiased guidelines sponsored by the National Stroke Association were recently reported in Annals of Neurology, which underline the need for urgent evaluation and treatment of individuals who experience TIA.

Fifteen selected experts carried out a systematic literature review and identified 257 published sets of guidelines on TIA, 13 of which met the entry criteria for their study. The recommendations derived from the guidelines were independently assigned quality ratings, and those with the highest ratings were edited through a series of questionnaires until a consensus was reached on the wording of the new recommendations. The final 53 recommendations were then rated on the basis of their level of evidence and quality.

Five major categories of recommendation are included in the new guidelines: initial management; evaluation; medical treatment; surgical treatment; and risk factor management. At the conclusion of the study process, the experts agreed that all of the recommendations could also be applied to patients who had recently experienced a minor ischemic stroke.

The authors conclude that the new guidelines should receive wide distribution amongst clinicians caring for patients with TIAs, not only through brochures and pocket cards, but also through a website that has been created, which will be updated as required.