What is your approach to the management of asymptomatic intracranial atherosclerosis discovered during the workup of an acute stroke?

I would maximize the treatment of vascular risk factors such as hypertension, elevated cholesterol, and diabetes. The patient will be taking an antithrombotic medication for the acute stroke so that will also reduce the risk of stroke related to ICAD.

I agree with Dr. @Dr. First Last. If they're young or the amount of athero seems excessive, I may also check Lp(a). I also prescribe long-term cilostazol (100 mg BID) in addition to aspirin or clopidogrel (e.g., CSPS.com) in select patients whom I view to be at higher risk. This may well qualify as ...

I would maximize the management of vascular risk factors and have the patient take aspirin.