However, there were 6 vas- cular deaths (3.4%) in the warfarin arm and none in the dual antiplatelet arm (log-rank test, P=0.013), suggesting no advantage of warfarin over dual anti- platelets. It is not known whether DAPT is prefera- ble to single antiplatelet therapy (SAPT), but recent have suggested that long-term DAPT generally confers increased bleeding risk without a corresponding increased antithrombotic benefit. There is strong evidence that aspirin is effective in the secondary prevention of noncardioembolic stroke or TIA.383,385 Thus, in the absence of compel- ling evidence for an alternative, more effective anti- thrombotic treatment, long-term monotherapy with aspirin is recommended. Minor strokes that meet the inclusion criteria for the POINT study (Platelet- Oriented Inhibition in New TIA and Minor Ischemic Stroke) also should be treated with short-term DAPT with both aspirin and clopidogrel. Knowledge Gaps and Future Research Knowledge gaps within this area include the following: CLINICAL STATEMENTS AND GUIDELINES Kleindorfer For patients with a stroke or TIA and evidence of an aortic arch atheroma, the effectiveness of long-term DAPT with aspirin and clopidogrel compared with aspirin monotherapy therapy to prevent recurrent stroke is unknown. For patients with a stroke or TIA and evidence of an aortic arch atheroma, the effectiveness of anti- coagulation with either warfarin or a direct-acting anticoagulant compared with aspirin monotherapy to prevent recurrent stroke is unknown. For patients with a stroke or TIA and evidence of an aortic arch atheroma, the effectiveness of com- bination antiplatelet and anticoagulation therapy compared with aspirin monotherapy to prevent recurrent stroke is unknown. Optimal treatment strategies depending on plaque morphology and duration of treatment strategies remain unknown. 5.2. Moyamoya Disease Recommendations for Moyamoya Disease Referenced studies that support recommendations are summarized in online Data Supplement 30. 