How would you approach antithrombotic therapy in patients with acute ischemic infarcts and a non-occlusive intracranial thrombus?  

I agree with the previous answer and can expand on a few key management nuances involving stroke size, symptom severity, and etiology. For stroke size, I typically initiate anticoagulation (heparin drip) if less than one-third of the affected territory is involved, extrapolating from tPA guidelines....

I am unaware of data on this question, but it makes sense that an intraluminal thrombus might cause further ischemia. I would favor a few days of IV heparin, followed by reimaging and switching to antiplatelet Rx if the thrombus has resolved.

While there are no clinical trials that guide us to what the best approach is. I usually try to discern first if what we see is atherosclerotic stenosis or a non-occlusive thrombus. If someone had a prior CTA or MRA available then I would compare the vessels in terms of if there was prior stenosis o...