Do you recommend any medical management for patients with evidence of intracranial atherosclerosis without evidence for stroke?

I would focus more on primary prevention strategies, including lifestyle modifications and high-intensity statin therapy if LDL is elevated. The evidence supporting antiplatelet therapy for primary prevention in patients with stroke risk or intracranial atherosclerosis is either lacking or not stron...

Agree with the above answers. I also look at the presence of microvascular changes, and if present at Fazeka 2 or higher grades (with or without silent infarct), then in addition to strict risk factor control, screening and management of underlying sleep disorders, I do start an antiplatelet, provid...

If the MRI shows no silent strokes, antiplatelet meds would be considered if the patient has significant vascular risk factors.

As long as there are no contraindications, prophylaxis seems logical.