Previous CEA trials were initiated >30 years ago, and clinicians need comparisons of CEA with cur- rently available intensive medical therapy options. As a result of the growing elderly population, more data are needed on the merits of carotid revascular- ization in elderly patients (>80 years of age). Additional information is needed on the mecha- nisms of sex differences in outcomes for patients with symptomatic carotid stenosis. Recent studies have identified that carotid plaques with <50% stenosis but high-risk features may be linked to otherwise cryptogenic ischemic strokes. More information is needed on the frequency and optimal treatment of these nonstenotic plaques with high-risk features. 5.1.3. Aortic Arch Atherosclerosis Recommendations for Aortic Arch Atherosclerosis Referenced studies that support recommendations are summarized in online Data Supplement 29. COR LOE Recommendations In patients with a stroke or TIA and evidence of an aortic arch atheroma, intensive lipid management to an LDL cholesterol target <70 mg/dL is recommended to prevent recur- In patients with a stroke or TIA and evidence of an aortic arch atheroma, antiplatelet therapy is recommended to prevent recurrent Synopsis studies using TEE have identified complex aortic arch plaque to be inde- pendently and strongly associated with ischemic stroke. Prospective studies have found an increased stroke recurrence rate among patients with aortic plaques 4 mm in thickness, particularly with ulceration or mobile or without plaque calcifications.389 There are no strong data from randomized clinical trials or even observational studies that management should be dif- ferent from general secondary prevention recommenda- tions for atherosclerotic stroke. Recommendation-Specific Supportive Text 1. 