AHA/ASA Guidelines for the Definition and Evaluation of Transient Ischemic Attack
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Ischemic Stroke Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
AHA/ASA Guidelines for the Definition and Evaluation of Transient Ischemic Attack
Definition
Arguments in favour of definition
| Class III |
| "1." A 24-hour duration of symptoms does not accurately demarcate patients with and without tissue infarction. (Level of Evidence:A ) " |
| "2." The frequency distribution of durations of transiently symptomatic cerebral ischemic events shows no special relationship to the 24-hour time point.(Level of Evidence:A ) " |
| Class I |
| "1." Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies(Level of Evidence:C ) " |
| Class IIa |
| "1."A tissue-based definition of TIA will harmonize cerebrovascular nosology with other ischemic conditions and appropriately direct diagnostic attention to identifying the cause of ischemia and whether brain injury occurred.(Level of Evidence:C ) " |
Arguments against the new definition
| Class I |
| "1." Imaging studies currently play a central role in both determining the origin of and classifying acute cerebrovascular syndromes.(Level of Evidence:A ) " |
| Class IIa |
| "1.The new definition will modestly alter stroke and TIA prevalence and incidence rates, but these changes are to be encouraged, not discouraged, because they reflect increasing accuracy of diagnosis."(Level of Evidence:C) " |
| "2.The new definition will modestly alter stroke and TIA prevalence and incidence rates, but these changes are to be encouraged, not discouraged, because they reflect increasing accuracy of diagnosis."(Level of Evidence:C) " |
| "3.To facilitate comparison with prior studies, symptom duration is an important data element to collect in epidemiological studies."(Level of Evidence:C) " |
| "4.It would be reasonable to adopt a term such as acute neurovascular syndrome (see below) that can be used until
the diagnostic evaluation is completed or if a diagnostic evaluation is not performed."(Level of Evidence:C) " |
| "5.It is reasonable to use terms like cerebral infarction with transient signs without a fixed time criterion."(Level of Evidence:A) " |
| Class III |
| "1.We do not support linking any of these terms to a 24-hour time criterion because all cerebral infarction definitions with specific time limitations are capricious."(Level of Evidence:A) " |
| "2.It is impossible to define a specific time cutoff that can distinguish whether a symptomatic ischemic event will result in brain injury with high sensitivity and specificity."(Level of Evidence:A) " |
AHA-Endorsed Revised Definition of TIA
| Class IIa |
| "1.For patients with relatively brief symptom duration (eg, symptoms that persist several hours but less than a day) who do not receive a detailed diagnostic evaluation, it may be difficult to determine whether stroke or TIA is the most appropriate diagnosis. For these patients, it would be reasonable that a term such as acute neurovascular syndrome should be chosen, analogous to the terminology used in cardiology."(Level of Evidence:C) " |