Data from the THALES trial (Acute Stroke or Transient Ischaemic Attack Treated With Recommendations for Intracranial Large Artery Atherosclerosis (Continued) COR LOE Recommendations Antithrombotic Therapy (Continued) CLINICAL STATEMENTS AND GUIDELINES Kleindorfer Ticagrelor and ASA for Prevention of Stroke and Death; discussed in more detail in Section 5.19, Use of Antithrombotic Medications in Secondary Stroke Prevention) also inform recommenda- tions for short-term treatment with combination ticagrelor and aspirin in patients with atheroscle- rosis ipsilateral to the ischemic territory, including ICAS. In this prespecified subgroup analysis,340 risk of recurrent stroke or death at 30 days among patients with 30% intracranial stenosis ipsilateral to the ischemic event was 9.9% in the ticagrelor 90 mg twice a day plus aspirin 100 mg once a day group versus 15.2% in the aspirin 100 mg alone group (HR, 0.66 [95% CI, 0.47 0.93]; P=0.016). In contrast to the THALES patients without atherosclerosis, bleeding events among the ipsilateral atherosclerosis subgroup treated with ticagrelor and aspirin were not significantly higher than in those taking aspirin alone. Of note, THALES required loading doses of both ticagre- lor and aspirin. Also of note, in this analysis, ICAS was not required to be related to the index isch- emic event, so some patients may not have had symptomatic ICAS. Given the lack of comparative data between various dual-antiplatelet regimens in ICAS, the choice of adding ticagrelor or clopido- grel to aspirin should be based on patient factors such as medication adherence (eg, relative cost and dose frequency), but the role of genetic stud- ies or platelet function testing remains unclear. 4. Several RCTs have studied the efficacy of cilo- stazol 200 mg/d combined with other antiplate- let agents in patients with symptomatic ICAS. 