Ntaios G, Swaminathan B, Berkowitz SD, et al. - Researchers tested the safety and effectiveness of rivaroxaban compared with aspirin in embolic stroke of undetermined source (ESUS) and carotid atherosclerosis. Carotid atherosclerosis has either been analyzed as the presence of mild atherosclerotic stenosis or as the presence of carotid plaque separately. Investigators found that carotid plaque was present in 40% of candidates and mild carotid stenosis in 11%. No significant difference was found in ischemic stroke recurrence between rivaroxaban- and aspirin-treated patients among 490 patients with carotid stenosis and among 2,905 patients with carotid plaques. Major bleeding was more frequent in rivaroxaban-treated patients vs aspirin-treated among patients with carotid plaque. The authors discovered no distinction in effectiveness between rivaroxaban and aspirin for the avoidance of recurrent stroke in ESUS patients with carotid atherosclerosis, but aspirin was safer, compatible with the general test outcomes. For the qualifying ischemic stroke, a carotid plaque was present much more often than contralateral, promoting a significant etiological function of nonstenotic carotid disease in ESUS.