OBJECTIVE: Urgent evaluation and treatment of transient ischemic attack (TIA) 
patients in a dedicated TIA clinic may reduce the 90-day stroke risk by 80%. 
ABCD2 (Age, Blood pressure, Clinical features, Duration, Diabetes) score and 
magnetic resonance imaging abnormalities help to identify patients at high risk 
of stroke. Our aim was to determine whether the use of transcranial Doppler 
(TCD) examination on arrival at the TIA clinic yields additional information 
that facilitates the identification of patients at high risk of stroke 
recurrence.
METHODS: Between January 2003 and December 2007, 1,881 patients were admitted to 
SOS-TIA clinic (a TIA clinic with around-the-clock access). Clinical and 
vascular assessment included TCD performed by a neurologist immediately after 
admission. Stroke prevention measures were initiated on arrival, in accordance 
with guidelines. All patients were followed for 1 year after presentation to the 
SOS-TIA clinic.
RESULTS: A total of 1,823 TCD examinations were performed within 4 hours of 
admission. Intracranial narrowing or occlusion was found in 8.8% of patients, 
and was independently associated with age, hypertension, and diabetes. After 
1-year follow-up on best preventive therapy, the incidence of recurrent vascular 
events (intracranial revascularization for TIA recurrence, stroke, myocardial 
infarction, and vascular death combined) was 7.0% in patients with intracranial 
narrowing or occlusion and 2.4% in those without (log-rank, p = 0.007). The 
hazard ratio of combined outcome for the presence of intracranial narrowing or 
occlusion was 2.29 (95% confidence interval [CI], 1.15-4.56; p = 0.02) in 
multivariate analysis including age, gender, hypertension, and diabetes, and was 
2.50 (95%CI, 1.24-5.05; p = 0.01) in multivariate analysis including ABCD2 score 
> or =4.
INTERPRETATION: Immediate TCD examination on arrival at the TIA clinic is 
feasible and could help to identify patients at high risk of vascular events 
recurrence. This study supports a systematic intracranial vascular examination 
in the initial management of TIA.