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National Stroke Association guidelines for the management of transient ischemic attacks

  1. S. Claiborne Johnston MD, PhD1,2,†,*,
  2. Mai N. Nguyen-Huynh MD1,†,
  3. Miriam E. Schwarz BS1,†,
  4. Kate Fuller MA1,†,
  5. Christina E. Williams BA, MS1,†,
  6. S. Andrew Josephson MD1,†,
  7. Graeme J. Hankey MBBS, MD3,‡,
  8. Robert G. Hart MD4,‡,
  9. Steven R. Levine MD5,‡,
  10. Jose Biller MD6,‡,
  11. Robert D. Brown Jr MD, MPH7,‡,
  12. Ralph L. Sacco MD, MS8,‡,
  13. L. Jaap Kappelle MD9,‡,
  14. Peter J. Koudstaal MD10,‡,
  15. Julien Bogousslavsky MD11,‡,
  16. Louis R. Caplan MD12,‡,
  17. Jan van Gijn MD13,‡,
  18. Ale Algra MD14,‡,
  19. Peter M. Rothwell MD, PhD15,‡,
  20. Harold P. Adams MD16,‡,
  21. Gregory W. Albers MD17,‡

Article first published online: 15 AUG 2006

DOI: 10.1002/ana.20942

Issue

Annals of Neurology

Annals of Neurology

Volume 60, Issue 3, pages 301–313, September 2006

Additional Information

How to Cite

Johnston, S. C., Nguyen-Huynh, M. N., Schwarz, M. E., Fuller, K., Williams, C. E., Josephson, S. A., Hankey, G. J., Hart, R. G., Levine, S. R., Biller, J., Brown, R. D., Sacco, R. L., Kappelle, L. J., Koudstaal, P. J., Bogousslavsky, J., Caplan, L. R., van Gijn, J., Algra, A., Rothwell, P. M., Adams, H. P. and Albers, G. W. (2006), National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol., 60: 301–313. doi: 10.1002/ana.20942

Author Information

  1. 1

    Department of Neurology, University of California, San Francisco, CA

  2. 2

    Department of Epidemiology and Biostatistics, University of California, San Francisco, CA

  3. 3

    Department of Neurology, Royal Perth Hospital, Perth, Australia

  4. 4

    Department of Medicine, Division of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX

  5. 5

    Stroke Center, Department of Neurology, Mount Sinai School of Medicine, New York, NY

  6. 6

    Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL

  7. 7

    Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN

  8. 8

    Departments of Neurology and Epidemiology, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY

  9. 9

    Department of Neurology and Neurosurgery, Rudolf Magnus Institute, University Medical Center, Utrecht

  10. 10

    Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands

  11. 11

    Department of Neurology; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

  12. 12

    Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA

  13. 13

    Department of Neurology and Neurosurgery, Rudolf Magnus Institute, University Medical Center, Utrecht, The Netherlands

  14. 14

    Department of Neurology and Neurosurgery, Rudolf Magnus Institute and the Julius Center for Health and Primary Care, University Medical Center, Utrecht, The Netherlands

  15. 15

    Department of Clinical Neurology, Radcliffe Infirmary, Oxford, United Kingdom

  16. 16

    Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA

  17. 17

    Department of Neurology and Neurological Sciences, Stanford Stroke Center, Palo Alto, CA

  1. †

    Editorial team

  2. ‡

    Expert panel

*Department of Neurology, Box 0114, University of California, San Francisco, 505 Parnassus Avenue, M-798, San Francisco, CA 94143-0114

Publication History

  1. Issue published online: 18 SEP 2006
  2. Article first published online: 15 AUG 2006
  3. Manuscript Accepted: 30 JUN 2006
  4. Manuscript Received: 26 JUN 2006
  5. Manuscript Revised: 19 JUN 2006

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Abstract

Objective

Transient ischemic attacks are common and important harbingers of subsequent stroke. Management varies widely, and most published guidelines have not been updated in several years. We sought to create comprehensive, unbiased, evidence-based guidelines for the management of patients with transient ischemic attacks.

Methods

Fifteen expert panelists were selected based on objective criteria, using publication metrics that predicted nomination by practitioners in the field. Prior published guidelines were identified through systematic review, and recommendations derived from them were rated independently for quality by the experts. Highest quality recommendations were selected and subsequently edited by the panelists using a modified Delphi approach with multiple iterations of questionnaires to reach consensus on new changes. Experts were provided systematic reviews of recent clinical studies and were asked to justify wording changes based on new evidence and to rate the final recommendations based on level of evidence and quality. No expert was allowed to contribute to recommendations on a topic for which there could be any perception of a conflict of interest.

Results

Of 257 guidelines documents identified by systematic review, 13 documents containing 137 recommendations met all entry criteria. Six iterations of questionnaires were required to reach consensus on wording of 53 final recommendations. Final recommendations covered initial management, evaluation, medical treatment, surgical treatment, and risk factor management.

Interpretation

The final recommendations on the care of patients with transient ischemic attacks emphasize the importance of urgent evaluation and treatment. The novel approach used to develop these guidelines is feasible, allows for rapid updating, and may reduce bias. Ann Neurol 2006

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