Between the years 1964 and 1973, 225 patients with transient ischemic attacks (TIAs) due primarily to atherosclerosis were evaluated and treated. They have now been followed for from 3 to 14 years (average 5.5 years). As of 1976, 82 of the 225 patients were dead, 21 from cerebral infarction, 52 from heart disease and nine from other causes. Of the 56 untreated patients, 11 (19 percent) had cerebral infarctions, four (7 percent) of which were fatal; six (11 percent)were still having TIAs. Of the 45 patients medically treated, 10 (24 percent i had cerebral infarctions, three (7 percent) of which were fatal; 11 (25 percent) still experienced TIAs. In the surgical group of 124, 27 (21 percent) had postoperative cerebral infarctions, seven (6 percent) of which were fatal; 23 (18 percent) had cerebral infarctions during follow-up, of which seven (6 percent) were fatal; and 15 (12 percent) were still having TIAs. No statistically significant differences (p.0.05) related to cerebral infarction or TIAs developed among the three groups. The majority (23 percent) eventually succumbed to myocardial infarction, leading us to conclude that great emphasis must be placed upon TIAs as a warning for cardiac as well as cerebrovascular disease. © 1978 American Academy of Neurology.