Supracardiac Atherosclerosis in Embolic Stroke of Undetermined Source

The Underestimated Source

George Ntaios; Max Wintermark; Patrik Michel


Eur Heart J. 2021;42(18):1789-1796. 

In This Article


There is growing evidence highlighting the role of supracardiac atherosclerosis as an aetiology of ESUS. Advanced imaging methods are available to identify plaques which high embolic risk. With the wider implementation of advanced imaging in routine clinical practice, it will become increasingly easier to identify patients who had a stroke due to a vulnerable atherosclerotic plaque of <50% stenosis and accordingly, classify their stroke as a large artery atherosclerotic stroke, rather than ESUS. In this context, the term ESUS can be expected to progressively shrink as we become more and more efficient to reliably identify the actual cause of stroke.[62] The role of novel antithrombotic strategies in these patients needs to be assessed in randomized controlled trials.