In 2014, the new concept of embolic stroke of undetermined source (ESUS) was first proposed by cryptogenic stroke/ESUS International Working Group. In the past 5 years, related clinical researches of ESUS have been deepened, and the results of many large clinical studies have been published. However, the guiding significance of this new concept to clinical practice is still controversial. By reviewing the background, diagnostic criteria, assessment, common emboli sources, anticoagulant therapy research advances and related limitations of ESUS, and analyzing the possible causes of negative anticoagulant therapy results, we explored the clinical value of this new classification.
Cryptogenic stroke (CS) accounts for 25% of ischemic stroke. The etiology of undetermined stroke is unclear leading to untargeted secondary prevention, high recurrence rate, so the clinical burden of cryptogenic stroke is substantial. Cardiac magnetic resonance (CMR) imaging can identify more occult cardiac embolism that cannot be identified by standard cardiac assessment based on its excellent spatial resolution and contrast, three-dimensional imaging capacity and ability to depict soft tissues, to accelerate the initiation of optimal secondary prevention and improve the prognosis of patients. This review summarizes the application of CMR in the field of CS in recent years. Based on the latest evidence of diagnosis and management strategies, this paper proposes a cardiac diagnostic examination plan for CS patients, thereby improving the secondary prevention strategy of CS patients and improving their quality of life.
