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Transient ischemic attack (TIA) is a transient neurological dysfunction caused by focal ischemia of the brain, spinal cord or retina without acute cerebral infarction
.
In order to further promote the smooth progress of the National Health Commission’s stroke prevention and treatment project and regulate the management of high-risk populations of stroke, the "Guiding Standards for the Early Diagnosis and Treatment of Transient Ischemic Attack in China" was specially compiled, regarding the early diagnosis and evaluation of transient ischemic attack.
The article mainly involves the following content
.
Early diagnosis and evaluation of transient ischemic attack 1.
Within 2 to 7 days after the onset of TIA is the high-risk period of stroke, optimize the allocation of medical resources, and establish emergency medical care based on the ABCD2 score (Table 1) stratification and imaging Mode, start TIA assessment and secondary prevention as soon as possible
.
Table 1 ABCD2 score Table 2.
New TIA is treated as an emergency.
If the patient has one of the following conditions within 72 hours of the onset of symptoms, it is recommended to be admitted to the hospital: ①ABCD2 score ≥3 points; ②ABCD2 score 0-2 points, but not To ensure that the patient can complete the system examination in the outpatient clinic within 2 days; ③The ABCD2 score is 0 to 2 points, and there are other evidences that the symptoms are caused by ischemia
.
3.
Conduct a comprehensive examination and evaluation of patients with newly-onset TIA (Figure 1)
.
Figure 1 The process of triage of stroke patients (1) General examination: Evaluation includes electrocardiogram, complete blood count, coagulation function, blood electrolytes, renal function, and rapid blood glucose and lipid determination
.
(2) Vascular examination: CT angiography (CTA), magnetic resonance angiography (MRA), vascular ultrasound, and whole cerebral angiography (DSA) can find important intracranial and extracranial vascular diseases
.
Among them, DSA is the gold standard for preoperative evaluation of carotid endarterectomy (CEA) and carotid stenting (CAS)
.
(3) Evaluation of collateral circulation compensation and cerebral blood flow reserve: the application of DSA, cerebral perfusion imaging and/or transcranial color Doppler ultrasound (TCD) examination to assess collateral circulation compensation and cerebral blood flow reserve, for identification Hemodynamic TIA and guided treatment are very necessary
.
(4) Inspection of vulnerable plaque: vulnerable plaque is an important source of arterial emboli
.
Cervical vascular ultrasound, intravascular ultrasound, high-resolution MRI and TCD microembolic monitoring are helpful for the evaluation of atherosclerotic vulnerable plaques
.
(5) Cardiac evaluation: if cardiogenic embolism is suspected, or the cause of the neck and cerebrovascular examination and hematological screening is not clear under the age of 45, transthoracic echocardiography (TTE) and/or transesophageal echocardiography are recommended Image (TEE) examination may find multiple emboli sources such as heart mural thrombus, atrial septal abnormalities (atrioventricular aneurysm, patent foramen ovale, atrial septal defect), mitral valve vegetation, and aortic arch atherosclerosis
.
(6) Do other related examinations based on the medical history.
Although thrombolytic therapy for non-disabling ischemic cerebrovascular disease may benefit, the evidence is insufficient.
You can choose whether to perform thrombolytic therapy according to the actual situation of the physician and the patient
.
Yimaitong is compiled from: Medical Administration and Hospital Administration.
Chinese Guidelines for Stroke Prevention and Treatment (2021 Edition)-8.
Chinese Guidelines for Early Diagnosis and Treatment of Transient Ischemic Attack.
2021-8-31.
.
In order to further promote the smooth progress of the National Health Commission’s stroke prevention and treatment project and regulate the management of high-risk populations of stroke, the "Guiding Standards for the Early Diagnosis and Treatment of Transient Ischemic Attack in China" was specially compiled, regarding the early diagnosis and evaluation of transient ischemic attack.
The article mainly involves the following content
.
Early diagnosis and evaluation of transient ischemic attack 1.
Within 2 to 7 days after the onset of TIA is the high-risk period of stroke, optimize the allocation of medical resources, and establish emergency medical care based on the ABCD2 score (Table 1) stratification and imaging Mode, start TIA assessment and secondary prevention as soon as possible
.
Table 1 ABCD2 score Table 2.
New TIA is treated as an emergency.
If the patient has one of the following conditions within 72 hours of the onset of symptoms, it is recommended to be admitted to the hospital: ①ABCD2 score ≥3 points; ②ABCD2 score 0-2 points, but not To ensure that the patient can complete the system examination in the outpatient clinic within 2 days; ③The ABCD2 score is 0 to 2 points, and there are other evidences that the symptoms are caused by ischemia
.
3.
Conduct a comprehensive examination and evaluation of patients with newly-onset TIA (Figure 1)
.
Figure 1 The process of triage of stroke patients (1) General examination: Evaluation includes electrocardiogram, complete blood count, coagulation function, blood electrolytes, renal function, and rapid blood glucose and lipid determination
.
(2) Vascular examination: CT angiography (CTA), magnetic resonance angiography (MRA), vascular ultrasound, and whole cerebral angiography (DSA) can find important intracranial and extracranial vascular diseases
.
Among them, DSA is the gold standard for preoperative evaluation of carotid endarterectomy (CEA) and carotid stenting (CAS)
.
(3) Evaluation of collateral circulation compensation and cerebral blood flow reserve: the application of DSA, cerebral perfusion imaging and/or transcranial color Doppler ultrasound (TCD) examination to assess collateral circulation compensation and cerebral blood flow reserve, for identification Hemodynamic TIA and guided treatment are very necessary
.
(4) Inspection of vulnerable plaque: vulnerable plaque is an important source of arterial emboli
.
Cervical vascular ultrasound, intravascular ultrasound, high-resolution MRI and TCD microembolic monitoring are helpful for the evaluation of atherosclerotic vulnerable plaques
.
(5) Cardiac evaluation: if cardiogenic embolism is suspected, or the cause of the neck and cerebrovascular examination and hematological screening is not clear under the age of 45, transthoracic echocardiography (TTE) and/or transesophageal echocardiography are recommended Image (TEE) examination may find multiple emboli sources such as heart mural thrombus, atrial septal abnormalities (atrioventricular aneurysm, patent foramen ovale, atrial septal defect), mitral valve vegetation, and aortic arch atherosclerosis
.
(6) Do other related examinations based on the medical history.
Although thrombolytic therapy for non-disabling ischemic cerebrovascular disease may benefit, the evidence is insufficient.
You can choose whether to perform thrombolytic therapy according to the actual situation of the physician and the patient
.
Yimaitong is compiled from: Medical Administration and Hospital Administration.
Chinese Guidelines for Stroke Prevention and Treatment (2021 Edition)-8.
Chinese Guidelines for Early Diagnosis and Treatment of Transient Ischemic Attack.
2021-8-31.
