Introduction: Capsular warning syndrome (CWS) carries a significant risk of permanent stroke. There are no proven therapies for preventing completed stroke in this unstable situation.
Methods: Clinical observation in two patients with aspirin-resistant CWS treated with a loading dose of oral clopidogrel.
Results: Both patients had excellent neurological outcome, although one sustained an asymptomatic brain infarction.
Conclusion: High-dose oral clopidogrel plus aspirin merits formal evaluation in high-risk transient brain ischemia such as CWS, preferably in a randomized trial compared to aspirin alone.