New recommendation Anticoagulant therapy may be considered for patients with ST-segment elevation myocardial infarction and anterior apical akinesis or dyskinesis (Class IIb; Level of Evidence C). New recommendation Antithrombotic treatment and catheter-based closure are not recommended in patients with patent foramen ovale for primary prevention of stroke (Class III; Level of Evidence C). New recommendation Asymptomatic carotid stenosis Patients with asymptomatic carotid stenosis should be prescribed daily aspirin and a statin. Patients should also be screened for other treatable risk factors for stroke, and appropriate medical therapies and lifestyle changes should be instituted (Class I; Level of Evidence C). New recommendation. The use of aspirin and statin therapy was implied but not explicitly stated except in the perioperative and postoperative context in the prior guidelines. It is reasonable to consider performing carotid endarterectomy in asymptomatic patients who have >70% stenosis of the internal carotid artery if the risk of perioperative stroke, myocardial infarction, and death is low (<3%). However, its effectiveness compared with contemporary best medical management alone is not well established (Class IIa; Level of Evidence A). New recommendation It is reasonable to repeat duplex ultrasonography annually by a qualified technologist in a certified laboratory to assess the progression or regression of disease and response to therapeutic interventions in patients with atherosclerotic stenosis >50% (Class IIa; Level of Evidence C). New recommendation Prophylactic carotid angioplasty and stenting might be considered in highly selected patients with asymptomatic carotid stenosis (minimum, 60% by angiography, 70% by validated Doppler ultrasound), but its effectiveness compared with medical therapy alone in this situation is not well established (Class IIb; Level of Evidence B). 