Some
people call a transient ischemic attack (TIA) a mini-stroke, because the
symptoms are like those of a
stroke but do not last long. A TIA happens when blood
flow to part of the brain is blocked or reduced, often by a blood clot. After a
short time, blood flows again and the symptoms go away. With a stroke, the
blood flow stays blocked, and the brain has permanent damage.
A
TIA is a warning: It means you are likely to have a stroke in the future. If
you think you are having a TIA, call 911 . Early treatment can help prevent a
stroke. If you think you have had a TIA but your symptoms have gone away, you
still need to call your doctor right away.
What are the symptoms?
Symptoms of a TIA come on
suddenly.
One side of your body may feel numb, tingly, or
heavy.
You may not be able to move your arm, your leg, or your face
on one side of your body.
Things may look blurry or dim. You may
have double vision or not be able to see.
It may be hard to speak.
You may slur or mix up your words.
It may be hard to understand
words.
You may feel unsteady, dizzy, or clumsy. You may have
trouble walking.
What causes a transient ischemic attack?
A blood
clot is the most common cause of a TIA. Blood clots can be the result of
hardening of the arteries (atherosclerosis),
heart attack, or
abnormal heart rhythms. Brain cells are affected
within seconds of the blockage. That causes symptoms in the parts of the body
controlled by those cells. Once the clot dissolves, blood flow returns, and the
symptoms go away.
Sometimes a TIA is caused by a sharp drop in
blood pressure that reduces blood flow to the brain. This is called a
"low-flow" TIA. It is not as common as other types.
Your doctor will also check to see if something else is
causing your symptoms.
How is it treated?
Your doctor will start you on
medicines to help prevent a stroke. You may need to take several
medicines.
If tests show that the blood vessels (carotid arteries) in your neck are too narrow, you may
need surgery to open them up (carotid endarterectomy). This can help prevent
blood clots that block blood flow to your brain. Another type of surgery is
carotid artery stenting. During this surgery, the doctor puts a small tube
called a
stent inside your carotid artery. This helps keep the
artery open. Carotid artery stenting is not as common as endarterectomy.
You can do a lot to reduce your chance of having another TIA or a
stroke. Medicines can help, but you may need to make lifestyle changes
too.
Keep your blood pressure and
cholesterol under control.
If you have
diabetes, keep your blood sugar as close to normal as
possible.
Take a daily aspirin or other medicines, if your doctor
advises it.
Take your medicines just as your doctor says
to.
Eat a heart-healthy diet that includes plenty of fish, fruits,
vegetables, beans, high-fiber grains and breads, and olive oil.
Get plenty of exercise.
Stay at a healthy
weight.
If you smoke, quit. Avoid secondhand smoke
too.
Limit alcohol. Having more than 2 drinks a day raises the
risk of stroke.
Avoid getting sick from the
flu. Get a flu shot every year.
Blood clots that temporarily block
blood flow to the brain are the most common cause of
transient ischemic attacks (TIAs). Blood clots may
develop for a variety of reasons.
A blood clot can form in an artery that
supplies blood to the brain.
Blood clots usually form in arteries
damaged by
plaque buildup, which is a process called
atherosclerosis.
A blood clot can form in another part of the body
(often the heart) and travel through the bloodstream to an artery that supplies
blood to the brain. For example, clots may form:
In addition, an artery that is partially blocked with
plaque can reduce blood flow to the brain and cause
symptoms.
Rare causes of blood clots that can cause a TIA include:
Clumps of bacteria, tumor cells, or air bubbles
that move through the bloodstream.
Conditions that cause blood
cells to stick together. For example, having too many red blood cells (polycythemia), abnormal
clotting factors, or abnormally shaped red blood
cells, such as those caused by
sickle cell disease, may cause blood clots to form.
Inflammation in the blood vessels, which may develop from
conditions such as
syphilis,
tuberculosis, or other inflammatory
diseases.
A head or neck injury that results in damage to blood
vessels in the head or neck.
A tear in the wall of a blood vessel
located in the neck.
Symptoms
Symptoms of
transient ischemic attacks (TIAs) develop suddenly and
are always temporary. They usually go away within 10 to 20 minutes. TIA
symptoms are just like
stroke symptoms. They vary depending on which part of
the brain is affected. Common symptoms of TIA include:
Weakness on one side of your body or an
inability to move a part or all of one side of your body, such as your face,
arm, and leg.
Numbness, tingling, or a feeling of heaviness on one
side of your body.
Trouble seeing, such as blurring or double
vision, dimness, or a sensation that a shade has been pulled down over the
eyes.
Trouble speaking or finding words.
Trouble
understanding words.
Vertigo, unsteadiness, dizziness,
clumsiness, staggering, or fainting. You may have trouble walking. You may also
have a
drop attack, which is a sudden loss of strength in
your legs.
It is not always easy to recognize a transient ischemic
attack (TIA) because you may think that the symptoms are caused by normal aging
or other conditions. But you should treat any symptoms of a TIA as an emergency
because you have no way to know whether they are from a stroke or a TIA.
What Happens
Symptoms of a
transient ischemic attack (TIA) usually go away within
10 to 20 minutes, but some can last longer. If symptoms last longer than an
hour, it might be more likely that you have had a
stroke.
TIA symptoms, which are caused by
a blood clot that temporarily reduces blood flow to the brain, disappear when
the blood clot dissolves and blood flow returns.
A TIA is a
warning sign that a stroke may soon follow. Any symptoms of a TIA need to be
treated as an emergency.
Of those who survive a first TIA or stroke, 14%
will have another TIA or stroke within 1 year.1
A cluster of TIAs that increase in frequency,
become more severe, or last longer is a sign that a stroke may soon
occur.
A TIA also may signal an increased risk for a
heart attack.
Atherosclerosis, which is hardening of the arteries,
affects blood vessels throughout the body, including arteries that supply blood
to the heart and brain. Atherosclerosis that affects the blood vessels in the
heart (coronary arteries) may cause chest pain or a heart attack.
Conditions that cause blood cells to stick together and
form clots, such as having too many red blood cells (polycythemia),
abnormal
clotting factors, or abnormally shaped red blood
cells, such as those caused by
sickle cell disease.
When To Call a Doctor
Call 911 or other emergency services immediately if you have:
Sudden numbness, tingling, or weakness in or an
inability to move part or all of one side of your body, such as your face, arm,
and leg.
Brief vision changes that come on suddenly, such as
dimness, blurring, double vision, or loss of vision in one or both eyes
(usually described as a feeling that a shade is being pulled down over your
eyes).
Sudden difficulty speaking.
Sudden difficulty
understanding words.
Sudden dizziness, clumsiness, staggering,
trouble walking, or a
drop attack.
Sudden, severe headache that
is different from previous headaches and is without a known cause.
Had a TIA or stroke while taking aspirin or
other medicine that prevents blood clots, and you notice any
signs of bleeding.
Call your doctor today if you think you have had a TIA in
the past and have not yet talked with your doctor about your symptoms.
Watchful Waiting
Taking a wait-and-see approach, called watchful
waiting, is not appropriate if you are having symptoms of a TIA. Any symptoms
of a TIA need to be considered a medical emergency. Seek medical assistance
immediately.
Immediate evaluation is recommended
if you have had or are having a
transient ischemic attack (TIA). The purpose of
evaluation is to:
Check for another cause of your symptoms, such
as a
stroke, low blood sugar (if you have diabetes), or
Bell's palsy.
Look for a blood
clot.
Determine whether you need surgery to reopen a blocked artery
(carotid endarterectomy).
Determine whether you need medicines to
prevent blood clots.
If your TIA symptoms have completely disappeared, the
results of a
physical exam will be normal, and the diagnosis of a
TIA usually will be based on your
medical history and certain tests.
If a
TIA is suspected, the doctor may want to do tests, such as a:
CT scan of the head, to check for bleeding in the brain when symptoms of a TIA are
occurring and to check for evidence of a stroke or other disease, such as a
tumor.
MRI scan, to check for damage to the
brain from a stroke.
Further tests are often done to identify the underlying
cause of the TIA. If blockage of the
carotid arteries is suspected, you may have tests such
as:
Echocardiogram (echo) to examine the shape of the heart chambers and blood flow through
them.
Cholesterol and triglycerides tests to
check the level of these blood fats that can increase your risk for blood clots
and hardening of the arteries.
You may have other blood tests, such as a
complete blood count (CBC), based on your age and
medical history. Your doctor will use these tests to look for other causes of
the TIA.
Treatment Overview
If you have had a
transient ischemic attack (TIA), you will probably
need to take a medicine to help prevent blood clots. If the carotid arteries in
your neck are significantly blocked, you may also need to have surgery to
reopen the narrowed arteries. In addition, if you have
high blood pressure,
diabetes, or
high cholesterol, you will also need treatment for
those diseases.
Initial treatment
If you have symptoms of a
transient ischemic attack (TIA), seek medical help
immediately. If your symptoms have gone away, contact your doctor as soon as
possible. A TIA is a sign that a stroke may soon follow, and prompt medical
treatment may prevent a stroke. About 14% of people who survive a first TIA or
stroke will have another TIA or a stroke within a year.1
You will need to take medicine that will reduce
the risk of future blood clots. These medicines may include aspirin,
clopidogrel, dipyridamole with aspirin, or warfarin.
If your
carotid arteries are significantly blocked, you may
need surgery to reopen the narrowed arteries (carotid endarterectomy).
Endarterectomy surgery also may be appropriate for some people who have not had
a TIA but who have significant narrowing in an artery.
Another
option to reopen narrowed carotid arteries is
angioplasty with stenting. This procedure is much like
the one used to open up clogged heart arteries. A doctor threads a thin tube
called a catheter through an artery and up to the carotid arteries in your
neck, and then he or she inflates a tiny balloon to enlarge the narrowed
artery. The doctor places a wire mesh device called a stent in the artery to
keep it open. Carotid artery stenting is not as common as endarterectomy.
Ongoing treatment will focus on
preventing another
transient ischemic attack (TIA) or stroke and reducing
additional risk factors for stroke. This may include:
Reducing
high blood pressure, the most common risk factor for
stroke, by making changes to your diet and taking blood pressure-lowering
medicines.
Taking aspirin or another antiplatelet medicine to
prevent strokes. It has been shown that people who have had a stroke, a TIA, or
an endarterectomy may benefit from taking aspirin or another antiplatelet
medicine, such as aspirin with extended-release dipyridamole, daily to prevent
another stroke.
Taking
anticoagulant medicines, which are commonly called
blood thinners, if you have
atrial fibrillation. People with atrial fibrillation
who have had a TIA usually need to take anticoagulants, such as warfarin
(Coumadin, for example) to reduce their risk of stroke. Studies show that
anticoagulants are better than antiplatelet medicines (like aspirin) at
preventing strokes for this group of people.4 Some
people cannot take anticoagulants, however. In this case, you will probably be
given another medicine to reduce your chance of having a stroke.
Taking medicines such as
statins to lower
high cholesterol. Many studies show that statins
significantly reduce the risk of stroke in people who have had a TIA. Statins
even protect against stroke in people who do not have heart disease or high
cholesterol.5
Controlling
diabetes. Your doctor will advise that you try to keep
your blood sugar levels at normal or near-normal levels. To do this you may
need to take oral medicines or insulin. Eating a healthy diet and getting
plenty of exercise will also help.
Getting a flu shot every year to
help you avoid getting sick from the
flu.
You may also need to make lifestyle changes such
as:
Quitting smoking and avoiding secondhand
smoke. People who smoke have a higher risk of stroke than those who quit.
Stop-smoking programs, medicines, and counseling can boost your chances of
quitting for good.
Maintaining a healthy weight. Being overweight
increases your risk of developing high blood pressure, heart problems, and
diabetes, which are risk factors for TIA and stroke.
Eating a
balanced diet that is low in cholesterol, saturated fats, and salt. Fatty foods
may make hardening of the arteries worse. Increase
fruits and vegetables in your diet. For more
information, see:
Getting regular
exercise. Physical activity significantly lowers your
risk of stroke. Do activities that raise your
heart rate. Try to do
moderate activity, such as brisk walking, at least 2½
hours a week. One way to do this is to be active 30 minutes a day, at least 5
days a week. It's fine to be active in blocks of 10 minutes or more throughout
your day and week.6
Limiting alcohol. If
you drink alcohol, drink moderately. Moderate drinking is 2
drinks a day for men, and 1 drink a day for women.
Excessive use of alcohol-more than 2 drinks a day-can
raise your risk of stroke.
If you take warfarin, don't suddenly change your intake
of foods that are rich in vitamin K. Vitamin K can interfere with the action of
anticoagulants, making it more likely that your blood will clot. For more
information, see:
Watch for
signs of bleeding. Call your doctor if you are taking
aspirin or other medicines that slow blood clotting (such as warfarin,
clopidogrel, or aspirin with extended-release dipyridamole) and you notice
unusual bruising or bleeding. Follow these
safety tips when taking medicines that slow blood clotting.
Treatment if the condition gets worse
If you have
more than one
transient ischemic attack (TIA) close together (a
cluster of TIAs), you may be hospitalized because of the increased risk for
stroke.
Emergency treatment for stroke is most effective if done
within the first 3 hours after symptoms begin.
After you have an initial
evaluation for a TIA, you may need further testing and treatment on an
outpatient basis. But because of the increased risk of
stroke, staying in the hospital may be recommended
for:
People who have had more than one TIA close
together (a cluster of TIAs).
People who have had TIAs because of a
heart condition, such as
atrial fibrillation.
Those who have
symptoms which indicate that a large area of the brain is
affected.
Those whose symptoms last longer than an
hour.
Older adults and those with significant risk factors for
stroke, such as diabetes and heart disease.
Quit smoking. Daily
cigarette
smoking can increase the risk of stroke by 2½
times.7 Regular exposure to secondhand smoke also
increases your risk of stroke.2
Check with your doctor about whether you should take an aspirin
each day and medicine to lower your cholesterol, if you have been told that you
have hardening of the arteries (atherosclerosis). It has been shown that for people
who have had a stroke, a TIA, or an endarterectomy, daily taking aspirin or
other antiplatelet medicines, such as aspirin with extended-release
dipyridamole, may help prevent another stroke.
Ask your doctor
about taking cholesterol-lowering medicines such as
statins if you have high cholesterol or have had a
heart attack.
If you have had a prior TIA, taking blood pressure-lowering
medicines may help prevent another TIA or stroke.8
Maintain a healthy weight. Being overweight
increases your risk for high blood pressure, heart problems, and diabetes,
which are risk factors for TIA and stroke.
Eat a balanced diet that
is low in cholesterol, saturated fats, and salt. Eat a variety of
fruits and vegetables. Fatty foods may make hardening
of the arteries worse. For more information, see:
Get regular
exercise, and reduce your stress. Do activities that
raise your
heart rate. Try to do
moderate activity at least 2½ hours a week. One way to
do this is to be active 30 minutes a day, at least 5 days a week.6
Limit alcohol. If you drink alcohol, drink
moderately. Moderate drinking is 2
drinks a day for men, and 1 drink a day for women.
Excessive use of alcohol (more than 2 drinks a day)
can raise your risk of stroke.
Avoid taking birth control pills
(oral contraceptives) if you have other risk factors for TIA or stroke, such as
smoking, high cholesterol, or a history of blood clots. Talk to your doctor
about other forms of birth control that do not increase your risk of TIA and
stroke.
Avoid getting sick from the
flu. Get a flu shot every year.
Because atrial fibrillation increases your risk of stroke
and because many people do not have symptoms of atrial fibrillation, the
National Stroke Association recommends that everyone, particularly those age 55
or older, check his or her heartbeat once a month. To learn how to check your
pulse, see
taking your pulse. If you notice that your heartbeat does not have a regular
rhythm, talk to your doctor.
Home treatment is not appropriate for
a
transient ischemic attack (TIA). If you think you are
having a TIA, do not ignore the symptoms and do not try to manage them at home.
Seek emergency medical care when symptoms first appear.
Prompt treatment may keep you from having a
stroke.
If you have had a TIA recently:
Follow your treatment plan to help prevent
another TIA or stroke.
Call your doctor if you notice unusual
bruising or bleeding and you are taking aspirin or other medicines that slow
blood clotting (such as warfarin, clopidogrel, or aspirin with extended-release
dipyridamole). Follow these
safety tips when taking medicines that slow blood clotting, and be alert for
signs of bleeding.
Limit alcohol. If
you drink alcohol, drink moderately. Moderate drinking is 2
drinks a day for men, and 1 drink a day for
women.
Avoid getting sick from the
flu. Get a flu shot every year.
Medications
Your doctor will probably prescribe
several medicines after you have had a
transient ischemic attack (TIA). Medicines to prevent
blood clots are typically used, because blood clots can cause TIAs and
strokes.
The types of medicines that
prevent clotting are:
Antiplatelet
medicines.
Anticoagulant medicines.
Cholesterol-lowering and blood pressure-lowering medicines
are also used to prevent TIAs and strokes.
Antiplatelet medicines
Antiplatelets (such as aspirin, aspirin with
extended-release dipyridamole, or clopidogrel) keep
platelets in the blood from sticking together.
Aspirin is most often used to prevent TIAs
and strokes. Many studies have shown that aspirin helps prevent strokes and
reduces the risk of another TIA in people who have had their first
TIA.
Other antiplatelet medicines (such as clopidogrel) may be used
for people who cannot take aspirin or for whom aspirin has not been effective.
Aggrenox, a medicine that combines aspirin with dipyridamole,
is a safe and effective alternative to aspirin to prevent TIA and stroke for
some people.9
Anticoagulants
Anticoagulants prevent the
production of certain proteins that are needed for blood to clot. If you have
atrial fibrillation, you will probably take an
anticoagulant (such as warfarin). Anticoagulants are
more effective than antiplatelets in preventing strokes in people with atrial
fibrillation.4
Both anticoagulants and
antiplatelets increase the risk of bleeding. Warfarin (such as Coumadin) has
the highest risk of bleeding problems, but the risk is lower when the dosage is
closely monitored.
If you take warfarin, don't suddenly change
your intake of foods that are rich in vitamin K. Vitamin K can interfere with
the action of anticoagulants, making it more likely that your blood will clot.
For more information, see:
Experts recommend
that most people who have had a TIA take
statins, which lower cholesterol. Many studies show
that statins significantly reduce the risk of stroke in people who have had a
TIA. Statins even protect against stroke in people who do not have heart
disease or high cholesterol.5 For more information on
these medicines, see the topic
High Cholesterol.
Surgery
If you have significant blockage in the
carotid arteries in your neck, you may need a carotid endarterectomy. During
this surgical procedure, a surgeon removes
plaque buildup in the
carotid arteries to reduce the risk of
transient ischemic attack (TIA) or stroke. The
benefits and risks of this surgery must be carefully weighed, because the
surgery itself may cause a stroke. Your need to have carotid endarterectomy
depends on whether you have had a TIA and how much your carotid arteries have
narrowed.
You are most likely to benefit
from surgery if you have had a TIA in the past 6 months that was caused by a
70% or greater narrowing in one of your carotid arteries.
Carotid endarterectomy is
also appropriate if
your carotid arteries are moderately or severely blocked (50% to 70% or more)
and you have had one or more TIAs.10 Talk to your
doctor about whether a carotid endarterectomy is right for you.
A
relatively new procedure called
carotid artery stenting is another option for some
people who are at high risk of stroke. This procedure is much like coronary
angioplasty, which is commonly used to open blocked arteries in the heart.
During this procedure, a vascular surgeon inserts a metal tube called a
stent inside your carotid artery to increase blood
flow in areas blocked by plaque. The surgeon may use a stent that is coated
with medicine to help prevent future blockage. Carotid artery stenting is not
as common as endarterectomy.
Each person must carefully weigh the
benefits and risks of surgery and compare them with the benefits and risks of
using medicine to reduce the risk of TIA or stroke. The success of either
treatment will depend on the amount of blockage you have and which medicine you
use. Risks of surgery depend on your age, your health status, the skill and
experience of the surgeon, and the experience of the medical center where the
surgery is done.
Carotid endarterectomies are
most successful when they are done by a surgeon who is well trained in the
procedure and in a hospital that is well equipped to take care of any
complications that may occur during or after the procedure.
If you
are considering carotid endarterectomy, ask the hospital or state medical board
about the number of times complications have occurred in people that your
doctor has treated with this surgery and the complication rate at the hospital
where the surgery is to be done. The American Heart Association Stroke Council
recommends that surgery be performed by a surgeon who has complications in less
than 3% of those treated and that the hospital rate of complications be just as
low.10
While carotid endarterectomy
is often not done until several months after a TIA, a large study showed that
people benefit most from the surgery if it is done within 2 weeks of a TIA.
Delaying surgery longer than 2 weeks increases the risk for stroke because
people are more likely to have a stroke in the first few days and weeks after a
TIA. These results also point out why it is so important to see a doctor
immediately if you have any signs of TIA.11
Other Treatment
Carotid artery stenting is a procedure similar to one commonly used to open narrowed
arteries in the heart. Angioplasty combined with a
stent is now being done as an alternative to surgery
for preventing
transient ischemic attack (TIA) or stroke. In this
procedure, a doctor threads a thin tube called a catheter through an artery in
the groin and up to the carotid arteries in your neck. The doctor then uses a
tiny balloon to enlarge the narrowed portion of the artery and places a wire
mesh stent to keep the artery open. Carotid artery stenting is not as common as
carotid endarterectomy.
Other Places To Get Help
Organizations
National Institute of Neurological Disorders and
Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424 (301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA1 (1-800-242-8721)
Web Address:
www.americanheart.org
Call the American Heart Association (AHA) to find your
nearest local or state AHA group. AHA can provide brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support. AHA's Web site also has information on
physical activity, diet, and various heart-related conditions.
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
E-mail:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute (NHLBI)
information center offers information and publications about preventing and
treating heart, lung, and blood diseases.
National Stroke Association
9707 East Easter Lane, Building B
Centennial, CO 80112
Phone:
1-800-STROKES (1-800-787-6537)
Fax:
(303) 649-1328
E-mail:
info@stroke.org
Web Address:
www.stroke.org
This association provides education, information, referrals, and
research on stroke.
American Heart Association (2006). Heart disease and
stroke statistics-2006 update. Circulation, 113(6):
e85-e151.
Pearson TA, et al. (2002). AHA guidelines for primary
prevention of cardiovascular disease and stroke: 2002 update. Circulation, 106(3): 388-391.
Tanne D, et al. (2001). Blood lipids and first-ever
ischemic stroke/transient ischemic attack in the Bezafibrate Infarction
Prevention (BIP) registry: High triglycerides constitute an independent risk
factor. Circulation, 104(24):
2892-2897.
Saxena R, Koudstall PJ (2006). Anticoagulants versus
antiplatelet therapy for preventing stroke in patients with non-rheumatic
atrial fibrillation and a history of stroke or transient ischemic attack.
Cochrane Database of Systematic Reviews (1). Oxford:
Update Software.
Stroke Council (2004). Statins after ischemic stroke and transient ischemic attack: An advisory statement from the Stroke Council, American Heart Association and American Stroke Association. Available online: http://stroke.ahajournals.org/cgi/content/full/35/4/1023.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
Kasner SE, Morgenstern LB (2004) Cerebrovascular
disorders. In DC Dale, DD Federman, eds., ACP Medicine,
section 11, chap. 4. New York: WebMD.
PROGRESS Collaborative Group (2001). Randomised trial
of a perindopril-based blood pressure-lowering regimen among 6,105 individuals
with previous stroke or transient ischaemic attack. Lancet, 358(9287): 1033-1040.
ESPRIT Study Group (2006). Aspirin plus dipyridamole
versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): A
randomized controlled trial. Lancet, 367(9523):
1665-1673.
Biller J, et al. (1998). Guidelines for carotid
endarterectomy: A statement for healthcare professionals from a special writing
group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501-509.
Rothwell PM, et al., (2004). Endarterectomy for
symptomatic carotid stenosis in relation to clinical subgroups and timing of
surgery. Lancet, 363(9413): 915-924.
Other Works Consulted
American Heart Association and American College of
Cardiology (2006). AHA/ACC guidelines for secondary prevention for patients
with coronary and other atherosclerotic vascular disease: 2006 update.
Circulation, 113(19): 2363-2372. [Erratum in
Circulation, 113(22): 847.]
Brust J (2005). Transient ischemic attack. In LP
Rowland, ed., Merritt's Neurology, 11th ed., pp.
293-295. Philadelphia: Lippincott Williams and Wilkins.
Gami A (2006). Secondary prevention of ischaemic
cardiac events, search date July 2004. Online version of Clinical Evidence (15): 1-31.
Hirsch J, et al. (2008). Executive summary: American
College of Chest Physicians evidence-based clinical practice guidelines (8th
ed.). Chest, 133(6): 71-109.
Sacco RL, et al. (2006). Guidelines for prevention of
stroke in patients with ischemic stroke or transient ischemic attack.
Stroke, 37(2): 577-617.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
American Heart Association (2006). Heart disease and
stroke statistics-2006 update. Circulation, 113(6):
e85-e151.
Pearson TA, et al. (2002). AHA guidelines for primary
prevention of cardiovascular disease and stroke: 2002 update. Circulation, 106(3): 388-391.
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