This question is in regard to my father-in-law (78 yr. old male).Last week experienced TIA, immediately hospitalized. CT scan-no masses, no bleed, minimal cerebral atrophy. Heparinized and next day second TIA. Cerebral angio-Approx.50 % stenosis bilaterally, plaque seen on left, symptoms of TIA were right sided. Vascular consult-no immediate surgery,(small vessel disease??), Plavix,ASA, Lipitor, followup in 6 months. Should embolic phenom. recur carotid exploration necessary. Neurologist suggested ASA,Coumadin, Lipitor. No permanent neuro deficit from TIA's. Past medical history: COPD (coal miner 25 yrs.), A-fib. approx. 1 year ago (acute onset), normal sinus rhythm for past year. Lumbar disc approx. 4 years ago. Recent echo- essent. normal My dilema are the statistics for a future stroke and possible permanent neuro deficit with this wait and see approach. My father-in-law is active in his gardening and lives with my wife and I. Do you feel second opinion warranted? If so neurologist or vascular? Immediacy of second opinion? Please suggest someone at Cleveland Clinic if warranted. My daughter is a senior at Case so second opinion in Cleveland wouldn't be a problem. Thank you! Trying to get my father-in-law the best possible medical care in regard to this recent problem. Sincerly, Lawrence W. Olenginski,C.R.N.A.