The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death (THALES) study was designed to test the hypothesis that 30-day treatment with ticagrelor and aspirin would be superior to aspirin alone in reducing the risk of subsequent stroke or death in patients who had a non-cardioembolic ischemic stroke or transient ischemic attack.

A recent advance in ischemic stroke treatment is the mobile stroke unit, an ambulance outfitted with specialized equipment, computed tomography for brain imaging, and a specialized team with a stroke neurologist available either onboard or via telemedicine. Intravenous thrombolytics can be administered at the scene with the patient on the ambulance.

Endovascular mechanical thrombectomy has become the standard treatment for patients with acute ischemic stroke caused by large vessel occlusion in both the anterior and posterior circulations. This is predicated on the ability to perform the procedure in a timely fashion or based on a mismatch between the size of infarction and brain perfusion.

Cilostazol is a phosphodiesterase 3 inhibitor widely used in Asia for secondary stroke prevention but approved for use in North America only for symptomatic peripheral vascular disease. It has been theorized that cilostazol might be beneficial in preventing the progression of small vessel disease in the brain and, therefore, may have a secondary effect in preventing vascular dementia.

Following ischemic stroke in patients with non-valvular atrial fibrillation, the timing to restart anticoagulation treatment is uncertain and controversial. In addition, there is little data available regarding timing to restart anticoagulation following reperfusion therapy with either systemic thrombolysis and/or mechanical thrombectomy.

Although the data from this analysis suggest disability might be less with dual antiplatelet therapy, differences between the groups were small, did not show robust findings, and did not reach statistical significance in most of the analyses.