Are some strokes preventable? The potential role of transcranial doppler in transient ischaemic attacks of carotid origin

Summary Transient ischaemic attacks (TIA) are more than just ministrokes. The high frequency of early stroke following TIA has resulted in the recent publication of guidelines in the UK. The guidelines recommend that patients attend a neurovascular clinic within 7 days of the index event to expedite investigation and treatment and so reduce the risk of a subsequent (potentially more serious) neurological event. After a TIA or stroke caused by carotid-artery disease, there is an increase in cerebral microemboli detectable by transcranial doppler (TCD). High microembolic loads appear to be surrogate markers for future neurological events, and the pharmacological efficacy of therapeutic interventions can now be rapidly and non-invasively assessed in the clinic or at the bedside. Medical treatments can now be optimised, avoiding the need for urgent or emergency carotid surgery and therefore allowing patients to undergo safer elective surgery when appropriate.