2.4 Transient ischaemic attack (TIA)

TIA is known as a mini-stroke and defined as a focal neurological deficit lasting less than 24 hours caused by a focal, temporary cerebral ischaemia. Its  main  significance lies in the increased risk of subsequent stroke. A recent large international study found a 5% risk of stroke within one year of TIA[169]. An Italian study found a 6% and 11% risk of stroke within the first 7 and 90 days of TIA respectively[170]. Other studies also reported a particularly high risk in the first few days after TIA[171, 172]. Studies calculating the 90-day stroke risk for patients having been urgently assessed after TIA found much lower risks of subsequent stroke[173, 174].

Example from Croatia: “There is only one TIA Centre in Croatia providing best outpatient medical care within 24 hours (diagnostics and therapy) for low risk TIA or mild stroke patients[…] It has full access to all diagnostics (neuroimaging, cardiology, ultrasound, biochemistry) with the limitation of not being available on weekends so far. Other hospitals either admit TIA patients to general neurological wards or discharge them home for further workup”.[9]

Urgent assessment and starting of stroke prevention treatment is, therefore, essential to lower the very substantial risk of subsequent stroke.

There is little epidemiological data regarding the number of TIA events per population. Incidence of TIA in Europe was reported as 0.5-2.4 and 0.1-1.1 in men and women aged 55-64, rising to 3.0-7.2 and 2.2-8.1 in those aged 75-84[175]. Age-adjusted incidence rate was reported as 73 per 100,000 in Sweden[176], 25 in Italy (Udine)[170], and 29 in Spain[21]. Crude incidence was 101 per 100,000 in Croatia[177]. The proportion of the population which has experienced a TIA in the past was estimated at 0.5% in the UK[67], 1.3% in Spain[64], and 1.4% in Croatia[58].

In most European countries national stroke guidelines cover TIA management (Austria, Belgium, Bulgaria, Czech Republic, Finland, France, Ireland, Italy, Latvia, Luxembourg, Malta, Germany, Hungary, Sweden, Spain, and UK), while some countries use local guidelines (Croatia, Greece, and Slovakia). [9, 178]

Several European countries have to some extent a dedicated system for the care of people with TIA (immediate or same day evaluation of patients by a stroke specialist): Belgium[9], Croatia (one outpatient centre only[9]), Czech Republic, Denmark, France[179], Germany, Italy, Ireland, Israel, Portugal, Serbia, Slovakia, Slovenia[9] Spain, UK[169]). Several countries lack specialised outpatient services and TIA patients are usually admitted for diagnostic tests (Austria, Estonia, Slovakia[9]). However, there is no information available for several European countries and the extent, availability, and population coverage of the services in the countries listed above is largely unclear.

Example from Slovakia: “There is no chance for patients with TIA to pass all recommended examinations (ultrasound of carotid arteries, ECG, Holter monitoring, echocardiography, etc.) in short time (sometimes it could last 3 months). That is why they are admitted to hospital, where they pass most of these examinations in a few days (it depends on the hospital how many days) and most of them are discharged from hospital with secondary prevention”.[9]