Does the natural history of transient ischemic attacks (TIAs) justify surgery?

Factors influencing the survival of 451 transient ischemic attack patients.

“…For example, a young individual without heart disease suffering a TIA should theoretically fare better than an older person with it. Both Shah et al 3 and Muuronen and Kaste 2 recognized this possi-bility when they discussed that the differences between our population and that of Muuronen and Kaste could be attributable in part to the differences in the risk factor profile of the two populations. For example, 57% of our TIA patients had hypertension and 55% had cardiac disease compared with 27% and 17%, respectively, in the population of Muuronen and Kaste.…”

“…For example, our previously reported TIA population 1 had a 5-year survival of approximately 65%, while that of Muuronen and Kaste 2 had a 5-year survival of 90%. Recently, Shah et al 3 noted that the proper therapy for TIA would differ greatly depending on which reported mortality figures are considered. For example, assuming a surgical complication rate of 7% and a reduction in mortality following surgery of 33%, our center's 35% mortality for North Carolina may justify the consideration of surgical intervention, while the 10% mortality of Muuronen and Kaste for a Finnish population probably does not.…”