If you have had a transient ischemic attack (TIA), you will probably need to take a medicine to help prevent blood clots. If the carotid arteries in your neck are significantly blocked, you may also need to have surgery to reopen the narrowed arteries. In addition, if you have high blood pressure, diabetes, or high cholesterol, you will also need treatment for those diseases.

Initial treatment

If you have symptoms of a transient ischemic attack (TIA), seek medical help immediately. If your symptoms have gone away, contact your doctor as soon as possible. A TIA is a sign that a stroke may soon follow, and prompt medical treatment may prevent a stroke. About 14% of people who survive a first TIA or stroke will have another TIA or a stroke within a year.¹

You will need to take medicine that will reduce the risk of future blood clots. These medicines may include aspirin, clopidogrel, dipyridamole with aspirin, or warfarin.

If your carotid arteries are significantly blocked, you may need surgery to reopen the narrowed arteries (carotid endarterectomy). Endarterectomy surgery also may be appropriate for some people who have not had a TIA but who have significant narrowing in an artery.

Another option to reopen narrowed carotid arteries is angioplasty with stenting. This procedure is much like the one used to open up clogged heart arteries. A doctor threads a thin tube called a catheter through an artery and up to the carotid arteries in your neck, and then he or she inflates a tiny balloon to enlarge the narrowed artery. The doctor places a wire mesh device called a stent in the artery to keep it open. Carotid artery stenting is not as common as endarterectomy.

Should I have carotid endarterectomy surgery for TIA?

Ongoing treatment

Ongoing treatment will focus on preventing another transient ischemic attack (TIA) or stroke and reducing additional risk factors for stroke. This may include:

• Reducing high blood pressure, the most common risk factor for stroke, by making changes to your diet and taking blood pressure–lowering medicines.
• Taking aspirin or another antiplatelet medicine to prevent strokes. It has been shown that people who have had a stroke, a TIA, or an endarterectomy may benefit from taking aspirin or another antiplatelet medicine, such as aspirin with extended-release dipyridamole, daily to prevent another stroke.
• Taking anticoagulant medicines, which are commonly called blood thinners, if you have atrial fibrillation. People with atrial fibrillation who have had a TIA usually need to take anticoagulants, such as warfarin (Coumadin, for example) to reduce their risk of stroke. Studies show that anticoagulants are better than antiplatelet medicines (like aspirin) at preventing strokes for this group of people.⁴ Some people cannot take anticoagulants, however. In this case, you will probably be given another medicine to reduce your chance of having a stroke.
• Taking medicines such as statins to lower high cholesterol. Many studies show that statins significantly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.⁵
• Controlling diabetes. Your doctor will advise that you try to keep your blood sugar levels at normal or near-normal levels. To do this you may need to take oral medicines or insulin. Eating a healthy diet and getting plenty of exercise will also help.
• Getting a flu shot every year to help you avoid getting sick from the flu.