Professor Rothwell from the University of Oxford gave a presentation entitled “Is transient ischemic attack (TIA)/mini-stroke a medical emergency”, further emphasizing the importance of early diagnosis and timely treatment of TIA and mini-stroke. Professor Rothwell noted that approximately 15% of ischemic strokes are preceded by a TIA, which is an important early warning event for stroke. The greatest risk of delayed diagnosis and treatment of TIA and minor stroke is early stroke onset. data from five studies, including the Oxford hospital TIA study, Dutch TIA, UK TIA, NASCET and ECST, showed that the incidence of stroke within 7 days of a TIA episode was 0-0.9% and within 1 month was 0.5% to 2.2%. This rate is lower than actual due to the study design protocol. The general opinion is that the risk of stroke within 7 days of a TIA episode is 1 to 2%, within 1 month is 2%-4%, within 1 year is 10%-12%, and increases by 5% per year thereafter. Recent studies have shown that the risk of stroke within 7 days of a TIA is 8.0% (95% CI 2.3%-13.7%) and the risk of recurrent stroke within 7 days of a mini-stroke is l 1.5% (95% CI 4.8%-11.2%), which is much higher than previous estimates: the Anvil Sense Study showed that the cumulative risk of stroke increased with time after TIA and mini-stroke. The cumulative risk increases progressively with time after TIA and mini-stroke, reaching 15% to 20% at 90 days, with higher rates in the mini-stroke group. Current North American guidelines recommend that screening for TIA and mini-stroke must be completed within 1 week of the onset of stroke; UK guidelines require 2 weeks; SIGN requires 2 to 4 weeks. Professor Rothwell analyzed 800 stroke patients with TIA episodes, of whom about 32% had a stroke within 24/hours of the first TIA episode, 20% had a stroke within 24-48 hours, and less than 20% had an episode 7-14 days later. Professor Rothwell studied the risk of stroke recurrence within 3 months after a mini-stroke. A 0CsP staging analysis of 637 patients found that the recurrence rate was 22.9% in patients with partial anterior circulation infarction (PACI), 19.5% in patients with posterior circulation infarction (POCI), 5.4% in patients with lacunar infarction (LACI), and 3.9% in patients with complete anterior circulation infarction (TACI). The risk of early stroke recurrence after TIA or mini-stroke may be etiologically related, as reported in the literature. a meta-analysis of data from four studies, including OXVASC, O.CSP, Erlangcn, and Rochester, by Professor Rothwell et al. showed significant differences in the risk of stroke recurrence by subtype. Within 1 month after stroke, the risk of recurrence was highest for large-vessel stroke (OR=3.0, 95% CI 1.7-5.2), while small-vessel stroke (OR=0.22, 95% C10.1-0.7), cardiogenic embolism (OR=0.91, 95% C10.5-1.6), unexplained stroke (OR=1.05, 95% %C1 0.6-1.8) are also at risk of recurrence. The risk of recurrence is highest in large vessel strokes, and treatment often requires prompt carotid angiography and endarterectomy. Carotid endarterectomy reduces the risk of stroke in patients with carotid stenosis who have a TIA episode, and the ECsT study showed that the procedure significantly reduced the risk of stroke and death in 70% to 99% of patients with carotid stenosis. The results of the NASCErI’ study were similar. Professor Rothwetl combined data from the ECST and NASCET and noted that the efficacy of carotid endarterectomy correlated with gender, age, and degree of arterial stenosis. In addition, the time between the patient’s last TIA and the procedure is also an important factor in the efficacy of the procedure. 70-99% of patients with carotid stenosis, operated within 0-2 weeks after the onset of TIA, can just reduce the risk of ipsilateral ischemic stroke or death by 32.7%, while surgery after 12 weeks can only reduce this risk by 9.4%. In patients with arterial stenosis of 50% to 69%, surgery within 4 weeks of TIA can reduce the risk of ipsilateral ischemic stroke or death only. (Reproduced from Sun Weiping) The above conclusion: TIA and mini-stroke should be diagnosed early and treated promptly to reduce the possibility of “major stroke”.