Embolic stroke of undetermined source(ESUS)is currently considered to be a subtype of cryptogenic stroke featuring embolic stroke on imaging but with no specific or recognized cause of stroke identified after careful diagnos-tic evaluation.It was speculated that anticoagulant therapy was more effective than antiplatelet therapy for secondary pre-vention of stroke in patients with ESUS.However,in fact,several ESUS trials showed that anticoagulant therapy was nei-ther safer nor more effective compared with aspirin.Therefore,a more accurate understanding and determination of the eti-ology of ESUS is the key to treatment.In this paper,we discuss the background,definition,and diagnosis of ESUS,and analyze its etiology and the relationship between emboli and ESUS from the perspective of embolus source,with the aim to improve clinicians'understanding of ESUS.
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