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To review treatments for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (sICAS). The development of this practice advisory followed the process outlined in the American Academy of Neurology as amended. The systematic review included studies through November 2020. Recommendations were based on evidence, related evidence, principles of care, and inferences. Clinicians should recommend aspirin 325 mg/d for long-term prevention of stroke and death and should recommen