Diagnosis
A prompt evaluation of your symptoms is vital in diagnosing the cause of the TIA and deciding on a method of treatment. To help determine the cause of the TIA and to assess your risk of a stroke, your provider may rely on the following:
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Physical exam and tests. Your provider will perform a physical exam and a neurological exam. The provider will test your vision, eye movements, speech and language, strength, reflexes, and sensory system. Your provider may use a stethoscope to listen to the carotid artery in your neck. A whooshing sound (bruit) may indicate atherosclerosis. Or your provider may use an ophthalmoscope to look for cholesterol fragments or platelet fragments (emboli) in the tiny blood vessels of the retina at the back of the eye.
Your provider may check for risk factors of a stroke, including high blood pressure, high cholesterol levels, diabetes and in some cases high levels of the amino acid homocysteine.
- Carotid ultrasonography. If your provider suspects that the carotid artery may be the cause of your TIA, a carotid ultrasound may be considered. A wand-like device (transducer) sends high-frequency sound waves into the neck. After the sound waves pass through the tissue and back, your provider can analyze images on a screen to look for narrowing or clotting in the carotid arteries.
- Computerized tomography (CT) or computerized tomography angiography (CTA) scanning. CT scanning of the head uses X-ray beams to assemble a composite 3D look at the brain or evaluate the arteries in the neck and brain. CTA scanning uses X-rays similar to a standard CT scan but may also involve injection of a contrast material into a blood vessel. Unlike a carotid ultrasound, a CTA scan can evaluate blood vessels in the neck and head.
- Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA). These procedures, which use a strong magnetic field, can generate a composite 3D view of the brain. MRA uses technology similar to MRI to evaluate the arteries in the neck and brain but may include an injection of a contrast material into a blood vessel.
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Echocardiography. Your provider may choose to perform a traditional echocardiography called transthoracic echocardiogram (TTE). A TTE involves moving an instrument called a transducer across the chest. The transducer emits sound waves that bounce off different parts of the heart, creating an ultrasound image.
Or your provider may choose to perform another type of echocardiography called a transesophageal echocardiogram (TEE). During a TEE, a flexible probe with a transducer built into it is placed in the esophagus — the tube that connects the back of the mouth to the stomach.
Because the esophagus is directly behind the heart, clearer, detailed ultrasound images can be created. This allows a better view of some things, such as blood clots, that might not be seen clearly in a traditional echocardiography exam.
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Arteriography. This procedure gives a view of arteries in the brain not normally seen in X-ray imaging. A radiologist inserts a thin, flexible tube (catheter) through a small incision, usually in the groin.
The catheter is manipulated through the major arteries and into the carotid or vertebral artery. Then the radiologist injects a dye through the catheter to provide X-ray images of the arteries in the brain. This procedure may be used in selected cases.
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Treatment
Once your provider has determined the cause of the TIA, the goal of treatment is to correct the issue and prevent a stroke. Depending on the cause of the TIA, your provider may prescribe medication to reduce the tendency for blood to clot or may recommend surgery or a balloon procedure (angioplasty).
Medications
Providers use several medications to decrease the likelihood of a stroke after a TIA. The medication selected depends on the location, cause, severity and type of TIA. Your provider may prescribe:
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Anti-platelet drugs. These medications make the platelets, one of the circulating blood cell types, less likely to stick together. When blood vessels are injured, sticky platelets begin to form clots, a process completed by clotting proteins in blood plasma.
The most frequently used anti-platelet medication is aspirin. Aspirin is also the least expensive treatment with the fewest potential side effects. An alternative to aspirin is the anti-platelet drug clopidogrel (Plavix).
Your provider might prescribe aspirin and clopidogrel to be taken together for about a month after the TIA. Research shows that taking these two drugs together in certain situations reduces the risk of a future stroke more than taking aspirin alone. There may be certain situations when the duration of taking both medications together may be extended, such as when the cause of the TIA is a narrowing of a blood vessel located in the head.
Alternatively, your provider may prescribe ticagrelor (Brilinta) and aspirin for 30 days to decrease your risk of recurrent stroke.
Your provider may consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. The way dipyridamole works is slightly different from aspirin.
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Anticoagulants. These drugs include heparin and warfarin (Jantoven). They affect clotting-system proteins instead of platelet function. Heparin is used for a short time and is rarely used in the management of TIAs.
These drugs require careful monitoring. If atrial fibrillation is present, your doctor may prescribe a direct oral anticoagulant such as apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) or dabigatran (Pradaxa), which may be safer than warfarin.
Surgery
Carotid endarterectomy
Carotid endarterectomy
In carotid endarterectomy, a surgeon opens the carotid artery to remove the plaques that block it.
If you have a moderately or severely narrowed neck (carotid) artery, your provider may suggest carotid endarterectomy (end-ahr-tur-EK-tuh-me). This preventive surgery clears carotid arteries of fatty deposits (atherosclerotic plaques) before another TIA or stroke can occur. An incision is made to open the artery, the plaques are removed and the artery is closed.
Angioplasty
In selected cases, a procedure called carotid angioplasty, or stenting, is an option. This procedure involves using a balloon-like device to open a clogged artery and placing a small wire tube (stent) into the artery to keep it open.
Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Preparing for your appointment
A TIA often is diagnosed in an emergency situation, but if you're concerned about your risk of having a stroke, you can prepare to discuss the subject with your provider at your next appointment.
What you can do
If you want to discuss your risk of a stroke with your provider, write down and be ready to discuss:
- Your risk factors for a stroke, such as family history of strokes
- Your medical history, including a list of all medications, as well as any vitamins or supplements, you're taking
- Key personal information, such as lifestyle habits and major stressors
- Whether you think you've had a TIA and what symptoms you experienced
- Questions you might have
What to expect from your doctor
Your provider may recommend that you have several tests to check your risk factors. Your provider should tell you how to prepare for the tests, such as fasting before having your blood drawn to check your cholesterol and blood sugar levels.