Several RCTs have studied the efficacy of cilo- stazol 200 mg/d combined with other antiplate- let agents in patients with symptomatic ICAS. The TOSS-1 and TOSS-2 trials (Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis) found that cilostazol (200 mg/d) plus aspirin was as safe as aspirin alone or clopidogrel plus aspirin but was no better for stroke prevention in patients The CATHARSIS trial (Cilostazol- Aspirin Therapy Against Recurrent Stroke With Intracranial Artery Stenosis) reported that the combination of cilostazol and aspirin was superior to aspirin for the prevention of the combined sec- ondary end point of all vascular events and new but had no impact on ICAS progression.343 Subgroup analysis of the CSPS trial reported that patients with ICAS who were randomized to cilostazol plus either aspirin or clopidogrel (dual group) had a lower rate of stroke compared with those on aspirin or clopidogrel alone (4% versus Of note, these trials were conducted in a primarily Asian population, the dose of aspirin when used in com- bination with cilostazol did not exceed 150 mg/d, and many were unblinded. 5. Antithrombotic agents that have been specifically studied in RCTs of patients with ICAS include war- farin, aspirin, cilostazol, and the combination of clopidogrel plus aspirin or cilostazol. 6. 