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4 vs 37.6%; p=0.03). Patients with iCaW under conservative medical therapy had an annualized stroke recurrence rate (SRR) of 11.4% (95%CI [8.4-15.1]. iCaW was identified as a source of stroke in about 8% of a French population ≤65years with ACIS. iCaW was associated with a higher rate of LVO and a high SRR under conservative medical therapy. iCaW was identified as a source of stroke in about 8% of a French population ≤65 years with ACIS. iCaW was associated with a higher rate of LVO and a high SRR under conservative medical therapy.The