Although data from CREST suggest that women with CAS (relative to CEA) may be at higher risk for the composite outcome of stroke, death, or MI during the periprocedural period, this finding should be inter- preted with caution pending confirmation from other trials. At present, there may not be sufficient data to conclude that high-grade symptomatic or asymptomatic carotid stenosis should be managed differently in men and women with regard to the type of procedure, or whether it should be managed medically. Without definitive data, the recommendations in the guidelines for prevention of first or recurrent stroke should be applied to women.19,20,434 Aspirin for Prevention of Stroke in Women One of the seminal trials of primary prevention of CVD, including stroke, in women is the WHS, a randomized trial of 100 mg of aspirin on alternate days versus placebo in 39876 initially asymptomatic women 45 years of age, followed up for 10 years for a first major vascular event (nonfatal MI, non- fatal stroke, or cardiovascular death).435 Although there was a P=0.13) in the combined primary end point among women, the study found a 17% reduction in the risk of stroke (RR, reduction in the risk of IS (RR, 0.76; 95% CI, 0.63 0.93; P=0.009) and a nonsignificant increase in the risk of hemor- overall average stroke rates were 0.11% per year in aspirin- treated women and 0.13% per year in placebo- treated women (RR, 0.02% per year; number needed to treat, 5000). An important adverse outcome, gastrointestinal hemorrhage requiring transfusion, was more frequent in the aspirin group increase, 0.01% per year; number needed to harm, 10000). 