Researchers have demonstrated in a new study that intracranial occlusion in embolic stroke of undetermined source (ESUS) patients is not a risk factor for recurrent ischemic stroke. The research also indicated that anticoagulation did not reduce recurrence in those with or without intracranial occlusion. These results emphasize that intracranial occlusion in ESUS does not independently warrant anticoagulation treatment. The study was published in theJournal of the American Heart Associationby Matthew M. and colleagues. This multicenter retrospective cohort comprised 2,328 adults with cryptogenic stroke and was followed for a median of 1.31 years (interquartile range: 0.34–2.85). Of these, 999 patients (42.6%) presented with a proximal or medium/distal intracranial occlusion. Recurrent ischemic stroke was the main outcome and was measured using unadjusted and adjusted Cox proportional hazards models. For added robustness, the analyses were repeated following 1:1 propensity score matching and biweight kernel density matching. Intracranial occlusion patients had fewer atherosclerotic vascular risk factors, more severe stroke symptoms, and less severe cerebral microvascular disease than patients without intracranial occlusion. In spite of these differences, recurrence rates were nearly the same for the two groups: 6.8% per year (95% CI: 5.7–8.2) in intracranial occlusion patients 7.0% per year (95% CI: 6.0–8.1) in patients without intracranial occlusion The adjusted hazard ratio (HR) for recurrent stroke was 1.09 (95% CI: 0.77–1.55), which showed no significant difference. In propensity score matching, HR was 1.01 (95% CI: 0.64–1.59), and in kernel density models, HR was 0.95 (95% CI: 0.62–1.45). Notably, intracranial occlusion did not alter treatment with anticoagulation, sex, age, or high‐risk sources of embolism. These results indicate that intracranial occlusion in ESUS is not a predictor of increased stroke recurrence risk and anticoagulation provides no added value by occlusion status. This refutes the hypothesis that intracranial occlusions are similar to cardiac embolic sources regarding recurrence risk and warrants more directed therapeutic approaches. The study concluded that intracranial occlusion in patients with embolic stroke of undetermined source was not associated with higher recurrence of ischemic stroke. Moreover, the use of anticoagulation did not influence recurrence rates regardless of occlusion status.