By definition, a patient with a TIA has no residual symptoms from the primary event. The most significant risk to the patient is a second ischemic event causing permanent disability. Studies show that the rate of post-TIA stroke might have decreased slightly since 1999, likely related to advances in cardiovascular risk prevention.[10]Lioutas VA, Ivan CS, Himali JJ, et al. Incidence of transient ischemic attack and association with long-term risk of stroke. JAMA. 2021 Jan 26;325(4):373-81.
https://jamanetwork.com/journals/jama/fullarticle/2775447
http://www.ncbi.nlm.nih.gov/pubmed/33496774?tool=bestpractice.com
[125]Shahjouei S, Sadighi A, Chaudhary D, et al. A 5-decade analysis of incidence trends of ischemic stroke after transient ischemic attack: a systematic review and meta-analysis. JAMA Neurol. 2021 Jan 1;78(1):77-87.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2771410
http://www.ncbi.nlm.nih.gov/pubmed/33044505?tool=bestpractice.com
Studies from the early 2000s reported that for patients admitted for TIA, 8% had a stroke during their hospitalization and >10% of TIA patients seen in the emergency department had a stroke within 3 months.[80]Johnston SC, Gress DR, Browner WS, et al. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000 Dec 13;284(22):2901-6.
http://www.ncbi.nlm.nih.gov/pubmed/11147987?tool=bestpractice.com
[126]Daffertshofer M, Mielke O, Pullwitt A, et al. Transient ischemic attacks are more than "ministrokes." Stroke. 2004 Nov;35(11):2453-8.
https://www.ahajournals.org/doi/full/10.1161/01.str.0000144050.90132.8e
http://www.ncbi.nlm.nih.gov/pubmed/15486333?tool=bestpractice.com
However, a 2019 meta-analysis reported a 1.2% risk of stroke at 2 days and 7.4% risk of stroke at 90 days after TIA.[127]Najib N, Magin P, Lasserson D, et al. Contemporary prognosis of transient ischemic attack patients: a systematic review and meta-analysis. Int J Stroke. 2019 Jul;14(5):460-7.
https://www.doi.org/10.1177/1747493018823568
http://www.ncbi.nlm.nih.gov/pubmed/30632953?tool=bestpractice.com
TIA is also frequently indicative of underlying cardiac or atherosclerotic disease. As a result, despite complete resolution of symptoms from the TIA, disability and institutionalization are not uncommon. In the population-based Oxford Vascular Study, disability levels increased from 14% (modified Rankin Scale score >2) before a TIA to 23% at 5 years after the TIA. Occurrence of subsequent stroke was a major predictor of disability. The 5-year risk of institutionalization after TIA was 11%.[128]Luengo-Fernandez R, Paul NL, Gray AM, et al. Population-based study of disability and institutionalization after transient ischemic attack and stroke: 10-year results of the Oxford Vascular Study. Stroke. 2013 Oct;44(10):2854-61.
https://www.ahajournals.org/doi/10.1161/STROKEAHA.113.001584
http://www.ncbi.nlm.nih.gov/pubmed/23920019?tool=bestpractice.com