Transient Ischemic Attack Etiologic Subtype and Early Risk of Stroke

To the Editor: Although clinical features help stratify stroke risk after transient ischemic attack (TIA), the novel study by Purroy et al1 on predictors of early recurrent ischemia according to etiologic subtype of the index TIA emphasizes additional variables we must consider in our prognostication algorithms. We wish to discuss some issues raised in the article which we felt merited further exploration. The study found a very low recurrent event rate in the small-vessel disease (SVD) group (1.5%, or 1 event/68 patients). Transient lacunar events due to SVD are commonly thought to have a relatively benign prognosis, and these results support such an assertion. However, in our experience, lacunar events can often progress after a seemingly transient onset, and others have shown that lacunar …