Transient ischemic attack (TIA) is a common condition in France, affecting over 40,000 patients per year [1].

TIA is defined by the presence of a brief episode of neurological dysfunction caused by focal ischemia of the brain or retina, with clinical symptoms typically lasting less than an hour and no evidence of acute infarction according to the definition of the TIA Working Group published in 2002 [2].

TIA is a warning signal that can announce an imminent stroke, and previous studies demonstrated that about a quarter of stroke patients have a history of TIA with half occurring the week preceding the stroke [3]. Moreover, 10% of the patients who have had a TIA will experience a stroke within the following three months, with 50% occurring within 48 hours of the TIA [4]. Therefore, it appears crucial to consider the diagnosis and treatment of TIA as an emergency, especially since it has been demonstrated that early implementation of secondary stroke prevention strategies after TIA is associated with a 60 to 80% reduction in the risk of early recurrent stroke [5], [6].

While the benefit of emergency management is commonly recognized, there is no consensus on the care pathway protocol for TIA, particularly regarding hospitalization in an intensive stroke care unit compared to outpatient management in a TIA clinic. Hospitalization allows for patient monitoring and ensures rapid access to revascularization therapies in case of neurological deterioration, but these benefits may be offset by potential drawbacks of hospitalization and overuse of hospital resources. Therefore, in France as well as worldwide, management and hospitalization practices for TIA vary among practitioners, hospitals, and regions [7]. Several TIA care pathway models have been proposed mainly to reduce the hospital length of stay and costs and to improve outcomes. Among them, outpatient management in TIA clinics has been demonstrated to be safe and cost-effective, such as the TIA clinic of Bichat hospital, which was the first French TIA clinic created in 2003 by Philippa Lavallee [8]. In 2009 the French health authorities (Haute Autorité de santé, HAS) recommended that any suspected stroke or TIA should be managed and coordinated by stroke units to ensure rapid access to neurovascular expertise and cerebral imaging. However, for TIA patients, it was not specified whether this should be done through a hospitalization in the stroke unit or an outpatient management [9]. More recently in 2021, The European Stroke Organisation (ESO) guidelines recommended a specialist review in a TIA clinic within 24 hours over a conventional outpatient appointment more than 24 hours after the TIA. However, without evidence comparing each approach, these guidelines would be unable to determine the superiority of TIA clinics over stroke unit hospitalization [10]. In 2023, a survey was sent to the 139 French stroke unit managers by Dr Sablot with the support of the Société Française Neuro-Vasculaire (SFNV) to establish the status of TIA management in France. A TIA clinic was identified in only 12% of the stroke units, with only 2% officially recognized by the regional health agency [11].

In order to improve the management of TIA patients in the greater Bordeaux area, hereafter referred to as Bordeaux Metropole, our stroke unit's medical team decided, in 2022, to develop a project based on a hybrid model: a TIA clinic within the neurovascular unit operating as a day hospital with the possibility of hospitalization in the stroke unit for TIA patient at high risk of a recurrent stroke. The objective of this publication was first to describe the different steps that were necessary for the development of our TIA clinic that meets both the healthcare needs of Bordeaux metropole area and the architectural and economic constraints of our hospital, then to report the results of the first year of the clinic's activity.