What is the long term prognosis for a 58 year old man who had a TIA and clot buster with nearly full recovery?

I think it is important to note that this man did not have a TIA, but rather a stroke. By definition, a TIA, or "Transient Ischemic Attack", must have a duration of less than 24 hours. In other words, if this man suffered a TIA, he should be completely back to normal as opposed to having a "nearly full recovery."

That said, if he was diagnosed with a TIA, I have to assume that his symptoms were fairly mild. The clot buster medication may have enhanced his recovery from the stroke. Stroke symptoms typically get better with time, and most people I have treated who have an initial "nearly full recovery" go on to have a very nice long-term recovery, with very subtle to no deficit when compared to their pre-stroke level of function. Less commonly, little to no recovery is seen and the patient is left with a permanent dysfunction.