A case series of 7 patients with symptomatic FMD revealed no complications with balloon Knowledge Gaps and Future Research The optimal medical or interventional management of symptomatic FMD is unknown. Future prospective research evaluating the natural history of symptom- atic FMD on medical management compared with interventional management would be of interest and evolve to multicenter randomized trials comparing medical management (ie, antiplatelet versus anti- coagulant, then best medical therapy versus carotid angioplasty or carotid stenting) if enough patients can be identified. Recommendation for Dolichoectasia Referenced studies that support the recommendation are summarized in online Data Supplement 55. COR LOE Recommendation In patients with vertebrobasilar dolichoectasia and a history of ischemic stroke or TIA without other attributable causes, the use of antiplatelet or anticoagulant therapy is reasonable for the prevention of recurrent ischemic events.760 764 Synopsis Vertebrobasilar dolichoectasia is characterized by the fusiform dilatation and elongation and tortuosity of the vertebral and basilar arteries. Vertebrobasilar dolicho- ectasia is associated with traditional ischemic stroke risk factors such as increasing age, hypertension, and male sex. 