A retrospective analysis of patients with CeAD (n=161) comparing extracranial EVT (with and without stenting) with medical therapy alone found no difference in 90-day outcomes (adjusted OR, 0.62 [95% CI, 0.12 3.14]; P=0.56). With medical therapy alone, the overall prognosis and natural history of CeAD, including DAs, are favorable.379,380 Therefore, the benefit of extracranial EVT and stenting in patients with CeAD and definite recurrent cerebral ischemic events despite medical therapy is not well established. See Table LI in online Data Supplement 1. Powers et al 2019 Guidelines for Management of AIS e395 6.6.4. Hemorrhagic Transformation COR LOE New, Revised, or Unchanged For patients with AIS and HT, initiation or continuation of antiplatelet or anticoagulation therapy may be considered, depending on the specific clinical scenario and underlying indication. IIb C-LD Recommendation revised from 2014 Secondary Prevention. Several observational studies suggest that antithrombotics can be safely initiated or continued in patients with AIS and HT. In a prospective, open-label study of 60 patients with atrial fibrillation and either mild to moderate AIS with an NIHSS score <9 (n=49) or TIA (n=11) who were treated with rivaroxaban within 14 days of onset, 50 were available for follow-up at 7 days after drug initiation. None developed symptomatic HT. Of the 23 with AIS who had HT at baseline, 5 demonstrated asymptomatic radiographic progression, and 18 showed neither clinical nor radiographic progression. Of the remaining 27 who did not have HT at baseline, 3 developed asymptomatic HT.227 A retrospective stroke registry analysis identified 222 patients with AIS and HT. The frequency of composite events (neurological deterioration, vascular events, and death) at 1 month was significantly lower in patients treated with antithrombotics compared with those who were not (1.6% versus 11.1%; P=0.041). 