Do you use dual anti-platelet therapy inpatients with low NIHSS who have had bilateral brainstem strokes?

I usually look at the stroke mechanism in making my decisions about DAPT rather than just relying on the NIHSS alone. If the mechanism is ICAD, branch atherosclerotic disease, SVD (with infarct extension), embolism from the aortic arch plaque, subclavian artery heterogenous plaque, extra-cranial vertebral artery stenosis-then yes I use DAPT (after assessing swallow function and need for PEG). In the CHANCE and POINT trials, the patients with the most benefit were those with atherosclerotic and small vessel disease. If the mechanism is a hypercoagulable state or cardioembolism, then I focus on antithrombotic specific to the underlying respective etiology.