There is no RCT evidence that patients with AIS and symptomatic intracranial stenosis should be treated differently from other patients with ischemic stroke of presumed atherosclerotic cause. In the WASID RCT (Warfarin-Aspirin Symptomatic Intracranial Disease), warfarin provided no benefit over aspirin 325 mg/d, even in those who were taking antithrombotics at the time of the qualifying event.335 The SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) showed no benefit of adding Wingspan stenting to aggressive medical therapy that included aspirin 325 mg/d and clopidogrel 75 mg/d for 90 days after enrollment, again even in those who were taking antithrombotics at the time of qualifying event.336 338 The CHANCE trial, which compared dual antiplatelet treatment with clopidogrel and aspirin and aspirin alone for 21 days in patients with high-risk TIA and minor stroke, showed no evidence of preferential benefit from dual antiplatelet treatment in patients with intracranial arterial stenosis. Compared with pooled historical control subjects in WASID, the medical treatment only group in SAMMPRIS had an almost 2-fold lower risk of any stroke or death within 30 days or ischemic stroke in the territory of the qualifying artery after 30 days. Whether this was the result of dual antiplatelet treatment with aspirin and clopidogrel for 90 days remains to be demonstrated by an RCT.337 339 See Tables LXXIX and LXXX in online Data Supplement 1. Imaging of the intracranial vasculature to detect atherosclerotic stenosis of a major intracranial artery is reasonable in selected patients as part of a comprehensive evaluation to determine if they meet the eligibility criteria of the RCTs that investigated mechanical closure of PFO for prevention of recurrent stroke. IIa B-R New recommendation. 