The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org OR Discussion of Procedures by Variant Variant 1: Adult. Clinical transient ischemic attack (TIA). Symptoms resolved. Initial imaging. Transient ischemic attacks (TIA) are self-limited focal neurologic deficits resulting from a temporary interruption in blood supply to the brain, with no permanent clinical deficit or demonstrated infarct on subsequent imaging. In the United States, the incidence of TIA is approximately 1.2 per 1,000 [7]. The traditional time-based definition of TIA set the maximum duration at 24 hours. A newer imaging-based definition restricts the term TIA to those without neuroimaging evidence of tissue damage. Practically, those with and without tissue damage are considered together for diagnosis and management proposes [8,9]. Although symptoms may resolve within a short period of time, typically <1 hour, the risk for subsequent stroke is high: 8.8% at 7 days and 11.6% at 90 days [10]. In the setting of symptomatic carotid disease, the 90-day risk of ipsilateral stroke is 20.1% [11]. Given the high risk for stroke following TIA, expeditious initial imaging is important. There is a direct correlation between the risk of stroke following a carotid territory TIA or minor stroke and degree of carotid stenosis, and this drives the decision for carotid endarterectomy (CEA) or stenting [12,13]. Therefore, evaluation of patients with clinical carotid TIA or minor stroke requires rapid vascular imaging of the cervical carotid arteries [12,13] in addition to brain parenchymal imaging.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org OR Discussion of Procedures by Variant Variant 1: Adult. Clinical transient ischemic attack (TIA). Symptoms resolved. Initial imaging. Transient ischemic attacks (TIA) are self-limited focal neurologic deficits resulting from a temporary interruption in blood supply to the brain, with no permanent clinical deficit or demonstrated infarct on subsequent imaging. In the United States, the incidence of TIA is approximately 1.2 per 1,000 [7]. The traditional time-based definition of TIA set the maximum duration at 24 hours. A newer imaging-based definition restricts the term TIA to those without neuroimaging evidence of tissue damage. Practically, those with and without tissue damage are considered together for diagnosis and management proposes [8,9]. Although symptoms may resolve within a short period of time, typically <1 hour, the risk for subsequent stroke is high: 8.8% at 7 days and 11.6% at 90 days [10]. In the setting of symptomatic carotid disease, the 90-day risk of ipsilateral stroke is 20.1% [11]. Given the high risk for stroke following TIA, expeditious initial imaging is important. There is a direct correlation between the risk of stroke following a carotid territory TIA or minor stroke and degree of carotid stenosis, and this drives the decision for carotid endarterectomy (CEA) or stenting [12,13]. Therefore, evaluation of patients with clinical carotid TIA or minor stroke requires rapid vascular imaging of the cervical carotid arteries [12,13] in addition to brain parenchymal imaging.