Symptomatic Carotid Outcomes Registry

Inclusion Criteria: * Age ≥40 years plus stroke or TIA ipsilateral to 50-99% ICA stenosis In addition, patients must have at least one clinical or radiologic marker of reduced stroke risk Clinical Reduced Stroke RISK: 1. Retinal ischemia only (amaurosis fugax, branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO) 2. Female sex 3. Most recent stroke or TIA \>1 week ago Radiologic Reduced Stroke RISK: 1. Transcranial Doppler (TCD) study demonstrating lack of microembolic signals 2. Cross-sectional MRI plaque imaging demonstrating absence of intraplaque hemorrhage 3. For patients with TIA: brain MRI shows no DWI lesion Exclusion Criteria: Atrial fibrillation or other high-risk sources of cardiac embolism unless it is device detected AF only or duration \<6 minutes Alcohol and substance abuse within the prior 24 months Clinically significant bleeding diathesis (platelet count \<100K, prothrombin time \>14 seconds) Clear indication for therapeutic anticoagulation (for example, DVT or pulmonary embolism within past 3 months) Left ventricular ejection fraction \<20% Known allergy or intolerance to aspirin or clopidogrel Life expectancy less than 12 months Moderate/severe dementia (Mini-mental or MOCA score \<22 Modified Rankin score of \>4 Nonatherosclerotic cause of carotid stenosis Most recent symptomatic event \>180 days from the time of enrollment \-