arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2025-2573RHYIGQarthyper-2573Research ArticleСтатьиArticlesКриптогенный инсульт: кардиологические ключи к неврологической загадкеCriptogenic stroke: how cardiology can help solve a neurological puzzlehttps://orcid.org/0009-0002-3742-6454ДрешинаС. А.DreshinaS. A.

Дрешина Софья Александровна, врач-невролог, ординатор кафедры неврологии с клиникой,

ул. Аккуратова, д. 2, Санкт-Петербург, 197341.

Sofya A. Dreshina, Neurologist, Resident, Department of Neurology with Clinic, 

2, Akkuratov str., St Petersburg, 197341.

dreshina_sa@almazovcentre.ruhttps://orcid.org/0000-0002-6484-286XЯнишевскийС. Н.YanishevskiyS. N.

Янишевский Станислав Николаевич, доктор медицинских наук, доцент, заведующий научно-исследовательской лабораторией неврологии и нейрореабилитации,

ул. Аккуратова, д. 2, Санкт-Петербург, 197341.

Stanislav N. Yanishevskiy, MD, PhD, DSc (in Medicine), Associate Professor, Head, Laboratory of Neurology and Neurorehabilitation, Professor, Department of Neurology with Clinic, 

2, Akkuratov str., St Petersburg, 197341.

yanishevskiy_sn@almazovcentre.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CenterRussian Federation202530012026315383392Copyright © Дрешина С.А., Янишевский С.Н., 20262026Дрешина С.А., Янишевский С.Н.Dreshina S.A., Yanishevskiy S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2573

В настоящей статье подробно анализируются кардиологические аспекты этиологии криптогенного инсульта, в том числе ESUS (от англ. embolic stroke of undetermined source — эмболический инсульт из неустановленного источника эмболии). Особое внимание уделяется патофизиологическим механизмам и факторам риска развития кардиоэмболии при отсутствии инструментально подтвержденной фибрилляции предсердий. Детально рассматриваются несколько ключевых направлений: предсердная кардиопатия как комплекс структурных и функциональных изменений левого предсердия, субклиническая форма фибрилляции предсердий и аорто-артериальная эмболия, осуществляемая посредством нестенозирующих атеросклеротических бляшек, интракраниального атеросклероза и атероматоза дуги аорты. Представлен комплексный анализ современных диагностических биомаркеров, включая инструментальные (величина конечной части зубца P в отведении V1 на электрокардиограмме — PTFV1, наджелудочковые нарушения ритма, показатели структурных изменений левого предсердия) и лабораторные (N-концевой фрагмент мозгового натрийуретического пропептида, тропонин, D-димер), позволяющие идентифицировать скрытый эмбологенный субстрат. Освещены новые подходы в диагностике, в том числе расширенные протоколы электрокардиографического мониторинга, эхокардиографические методики и передовые методы визуализации сосудов. Подчеркивается необходимость комплексного раннего диагностического протокола, реализуемого в рамках персонализированного подхода.

This article analyzes the cardiological aspects of the etiology of cryptogenic stroke, including ESUS (embolic stroke of undetermined source). Special attention is paid to the pathophysiological mechanisms and risk factors for the development of cardioembolism in the absence of instrumentally confirmed atrial fibrillation. Several key areas are considered in detail: atrial cardiopathy as a complex of structural and functional changes in the left atrium, a subclinical form of atrial fibrillation and aorto-arterial embolism caused by non-stenosing atherosclerotic plaques, intracranial atherosclerosis and atheromatosis of the aortic arch. A comprehensive analysis of modern diagnostic biomarkers is presented, including instrumental (P-wave terminal force in lead V1 — PTFV1, supraventricular arrhythmias, indicators of structural changes in the left atrium) and laboratory ones (N-terminal pro-B-type natriuretic peptide, troponin, D-dimer), which identify the hidden embologenic substrate. New diagnostic approaches are highlighted, including advanced electrocardiographic monitoring protocols, echocardiographic techniques, and advanced vascular imaging techniques. The need for a comprehensive early diagnostic protocol implemented as part of a personalized approach is emphasized.

криптогенный инсультэмболический инсульт из неустановленного источника эмболииESUSпредсердная кардиопатияфибрилляция предсердийатеросклероз брахиоцефальных артерийатероматоз дуги аортыcryptogenic strokeembolic stroke of undetermined sourceESUSatrial cardiopathyatrial fibrillationatherosclerosis of the brachiocephalic arteriesatheromatosis of the aortic archReferencesHart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13(4):429– 438. https://doi.org/10.1016/S1474-4422(13)70310-7Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13(4):429– 438. https://doi.org/10.1016/S1474-4422(13)70310-7Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association / American Stroke Association. Stroke. 2021;52(7):e364–e467. https://doi.org/10.1161/STR.0000000000000375Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association / American Stroke Association. Stroke. 2021;52(7):e364–e467. https://doi.org/10.1161/STR.0000000000000375Hart RG, Catanese L, Perera KS, Ntaios G, Connolly SJ. Embolic stroke of undetermined source: a systematic review and clinical update. Stroke. 2017;48(4):867–872. https://doi.org/10.1161/STROKEAHA.116.016414Hart RG, Catanese L, Perera KS, Ntaios G, Connolly SJ. Embolic stroke of undetermined source: a systematic review and clinical update. Stroke. 2017;48(4):867–872. https://doi.org/10.1161/STROKEAHA.116.016414Ntaios G. Embolic stroke of undetermined source: JACC review topic of the week. J Am Coll Cardiol. 2020;75(3):333–340. https://doi.org/10.1016/j.jacc.2019.11.024Ntaios G. Embolic stroke of undetermined source: JACC review topic of the week. J Am Coll Cardiol. 2020;75(3):333–340. https://doi.org/10.1016/j.jacc.2019.11.024Kamtchum-Tatuene J, Wilman A, Saqqur M, Shuaib A, Jickling G. Prevalence of high-risk plaques and risk of stroke in patients with asymptomatic carotid stenosis: a meta-analysis. JAMA Neurol. 2020;77(12):1524–1535. https://doi.org/10.1001/jamaneurol.2020.2658Kamtchum-Tatuene J, Wilman A, Saqqur M, Shuaib A, Jickling G. Prevalence of high-risk plaques and risk of stroke in patients with asymptomatic carotid stenosis: a meta-analysis. JAMA Neurol. 2020;77(12):1524–1535. https://doi.org/10.1001/jamaneurol.2020.2658Kato Y, Takahashi S. Atrial cardiopathy and cryptogenic stroke. Front Neurol. 2022;13:839398. https://doi.org/10.3389/fneur.2022.839398Kato Y, Takahashi S. Atrial cardiopathy and cryptogenic stroke. Front Neurol. 2022;13:839398. https://doi.org/10.3389/fneur.2022.839398Yaghi S. Diagnosis and management of cardioembolic stroke. Continuum (Minneap Minn). 2023;29(2):462–485. https://doi.org/10.1212/CON.0000000000001217Yaghi S. Diagnosis and management of cardioembolic stroke. Continuum (Minneap Minn). 2023;29(2):462–485. https://doi.org/10.1212/CON.0000000000001217Демин Д.А., Кулеш А.А., Янишевский С.Н., Климчук Д.О., Мехряков С.А., Сыромятникова Л.И. и др. Криптогенный инсульт. Часть 3: предсердная кардиопатия и скрытая фибрилляция предсердий. Медицинский совет. 2022;16(21):8– 18. https://doi.org/10.21518/2079-701X-2022-16-21-8-18 [Demin DA, Kulesh AA, Yanishevskiy SN, Klimchuk DO, Mekhryakov SA, Syromyatnikova LI, et al. Cryptogenic stroke. Part 3: atrial cardiopathy and silent atrial fibrillation. Meditsinskiy Sovet = Medical Council. 2022;16(21):8–18. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-21-8-18]Демин Д.А., Кулеш А.А., Янишевский С.Н., Климчук Д.О., Мехряков С.А., Сыромятникова Л.И. и др. Криптогенный инсульт. Часть 3: предсердная кардиопатия и скрытая фибрилляция предсердий. Медицинский совет. 2022;16(21):8– 18. https://doi.org/10.21518/2079-701X-2022-16-21-8-18 [Demin DA, Kulesh AA, Yanishevskiy SN, Klimchuk DO, Mekhryakov SA, Syromyatnikova LI, et al. Cryptogenic stroke. Part 3: atrial cardiopathy and silent atrial fibrillation. Meditsinskiy Sovet = Medical Council. 2022;16(21):8–18. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-21-8-18]Hamer M, Kienzle M, Olshan A, Capasso R, Garan H, Ruskin J. Incidence of symptomatic atrial fibrillation in patients with paroxysmal supraventricular tachycardia. J Am Coll Cardiol. 1995;25(5):984–988. https://doi.org/10.1016/0735-1097(94)00521-2Hamer M, Kienzle M, Olshan A, Capasso R, Garan H, Ruskin J. Incidence of symptomatic atrial fibrillation in patients with paroxysmal supraventricular tachycardia. J Am Coll Cardiol. 1995;25(5):984–988. https://doi.org/10.1016/0735-1097(94)00521-2Gladstone D, Dorian P, Spring M, Panzov V, Mamdani M, Healey J, et al. Atrial premature beats predict atrial fibrillation in cryptogenic stroke: results from the EMBRACE trial. Stroke. 2015;46(4):936–941. https://doi.org/10.1161/STROKEAHA.115.008714Gladstone D, Dorian P, Spring M, Panzov V, Mamdani M, Healey J, et al. Atrial premature beats predict atrial fibrillation in cryptogenic stroke: results from the EMBRACE trial. Stroke. 2015;46(4):936–941. https://doi.org/10.1161/STROKEAHA.115.008714Yaghi S, Moon YP, Mora-McLaughlin C, Willey JZ, Cheung K, Di Tullio MR, et al. Left atrial enlargement and stroke recurrence: the Northern Manhattan Stroke Study. Stroke. 2015;46(6):1488–1493. https://doi.org/10.1161/STROKEAHA.115.008711Yaghi S, Moon YP, Mora-McLaughlin C, Willey JZ, Cheung K, Di Tullio MR, et al. Left atrial enlargement and stroke recurrence: the Northern Manhattan Stroke Study. Stroke. 2015;46(6):1488–1493. https://doi.org/10.1161/STROKEAHA.115.008711Fonseca A, Alves P, Inácio N, Marto J, Viana-Baptista M, Pinho-E-Melo T, et al. Patients with undetermined stroke have increased atrial fibrosis: a cardiac magnetic resonance imaging study. Stroke. 2018;49(3):734–737. https://doi.org/10.1161/STROKEAHA.117.019641Fonseca A, Alves P, Inácio N, Marto J, Viana-Baptista M, Pinho-E-Melo T, et al. Patients with undetermined stroke have increased atrial fibrosis: a cardiac magnetic resonance imaging study. Stroke. 2018;49(3):734–737. https://doi.org/10.1161/STROKEAHA.117.019641Kühnlein P, Mahnkopf C, Majersik J, Wilson B, Mitlacher M, Tirschwell D, et al. Atrial fibrosis in embolic stroke of undetermined source: a multicenter study. Eur J Neurol. 2021;28(11):3634–3639. https://doi.org/10.1111/ene.15022Kühnlein P, Mahnkopf C, Majersik J, Wilson B, Mitlacher M, Tirschwell D, et al. Atrial fibrosis in embolic stroke of undetermined source: a multicenter study. Eur J Neurol. 2021;28(11):3634–3639. https://doi.org/10.1111/ene.15022Bifulco S, Scott G, Sarairah S, Birjandian Z, Roney C, Niederer S, et al. Computational modeling identifies embolic stroke of undetermined source patients with potential arrhythmic substrate. Elife. 2021;10:e64213. https://doi.org/10.7554/eLife.64213Bifulco S, Scott G, Sarairah S, Birjandian Z, Roney C, Niederer S, et al. Computational modeling identifies embolic stroke of undetermined source patients with potential arrhythmic substrate. Elife. 2021;10:e64213. https://doi.org/10.7554/eLife.64213Stroke Prevention in Atrial Fibrillation Investigators. The stroke prevention in atrial fibrillation III study: rationale, design, and patient features. J Stroke Cerebrovasc Dis. 1997;6(5):341–353. https://doi.org/10.1016/S1052-3057(97)80217-0Stroke Prevention in Atrial Fibrillation Investigators. The stroke prevention in atrial fibrillation III study: rationale, design, and patient features. J Stroke Cerebrovasc Dis. 1997;6(5):341–353. https://doi.org/10.1016/S1052-3057(97)80217-0Gwak D, Kim Y, Park H, Kim M, Lee J, Kim S, et al. Impact of left atrial appendage morphology on recurrence in embolic stroke of undetermined source and atrial cardiopathy. Front Neurol. 2021;12:679320. https://doi.org/10.3389/fneur.2021.679320Gwak D, Kim Y, Park H, Kim M, Lee J, Kim S, et al. Impact of left atrial appendage morphology on recurrence in embolic stroke of undetermined source and atrial cardiopathy. Front Neurol. 2021;12:679320. https://doi.org/10.3389/fneur.2021.679320Nadarajah R, Wu J, Fröhlich H, Gale C. Future Innovations in Novel Detection for Atrial Fibrillation (FIND-AF): pilot study of an electronic health record machine learning algorithm-guided intervention to identify undiagnosed atrial fibrillation. Open Heart. 2023;10(2):e002331. https://doi.org/10.1136/openhrt-2023-002447Nadarajah R, Wu J, Fröhlich H, Gale C. Future Innovations in Novel Detection for Atrial Fibrillation (FIND-AF): pilot study of an electronic health record machine learning algorithm-guided intervention to identify undiagnosed atrial fibrillation. Open Heart. 2023;10(2):e002331. https://doi.org/10.1136/openhrt-2023-002447Cushman M, Judd S, Howard V, Kissela B, Gutiérrez O, Jenny N, et al. N-terminal pro-B-type natriuretic peptide and stroke risk: the reasons for geographic and racial differences in stroke cohort. Stroke. 2014;45(6):1646–1650. https://doi.org/10.1161/STROKEAHA.114.004712Cushman M, Judd S, Howard V, Kissela B, Gutiérrez O, Jenny N, et al. N-terminal pro-B-type natriuretic peptide and stroke risk: the reasons for geographic and racial differences in stroke cohort. Stroke. 2014;45(6):1646–1650. https://doi.org/10.1161/STROKEAHA.114.004712Merkler A, Gialdini G, Yaghi S, Okin P, Iadecola C, Navi B, et al. Association between troponin levels and embolic stroke of undetermined source. J Am Heart Assoc. 2017;6(9):e005905. https://doi.org/10.1161/JAHA.117.005905Merkler A, Gialdini G, Yaghi S, Okin P, Iadecola C, Navi B, et al. Association between troponin levels and embolic stroke of undetermined source. J Am Heart Assoc. 2017;6(9):e005905. https://doi.org/10.1161/JAHA.117.005905Adams H, Bendixen B, Kappelle L, Biller J, Love B, Gordon D, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41. https://doi.org/10.1161/01.STR.24.1.35Adams H, Bendixen B, Kappelle L, Biller J, Love B, Gordon D, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41. https://doi.org/10.1161/01.STR.24.1.35Elsheikh S, Hill A, Irving G, Lip G, Abdul-Rahim A. Atrial fibrillation and stroke: state-of-the-art and future directions. Curr Probl Cardiol. 2024;49:102181. https://doi.org/10.1016/j.cpcardiol.2023.102181Elsheikh S, Hill A, Irving G, Lip G, Abdul-Rahim A. Atrial fibrillation and stroke: state-of-the-art and future directions. Curr Probl Cardiol. 2024;49:102181. https://doi.org/10.1016/j. cpcardiol.2023.102181Vinding N, Kristensen S, Rørth R, Butt J, Kruuse C, Østergaard L, et al. Ischemic stroke severity and mortality in patients with and without atrial fibrillation. J Am Heart Assoc. 2022;11(19):e026723. https://doi.org/10.1161/JAHA.121.022638Vinding N, Kristensen S, Rørth R, Butt J, Kruuse C, Østergaard L, et al. Ischemic stroke severity and mortality in patients with and without atrial fibrillation. J Am Heart Assoc. 2022;11(19):e026723. https://doi.org/10.1161/JAHA.121.022638Freedman B, Camm J, Calkins H, Healey J, Rosenqvist M, Wang J, et al. Screening for atrial fibrillation: a report of the AF-SCREEN international collaboration. Circulation. 2017;135(19):1851–1867. https://doi.org/10.1161/CIRCULATIONAHA.116.026693Freedman B, Camm J, Calkins H, Healey J, Rosenqvist M, Wang J, et al. Screening for atrial fibrillation: a report of the AF-SCREEN international collaboration. Circulation. 2017;135(19):1851–1867. https://doi.org/10.1161/CIRCULATIONAHA.116.026693Freedman B, Potpara T, Lip G. Stroke prevention in atrial fibrillation. Lancet. 2016;388(10046):806–817. https://doi.org/10.1016/S0140-6736(16)31257-0Freedman B, Potpara T, Lip G. Stroke prevention in atrial fibrillation. Lancet. 2016;388(10046):806–817. https://doi.org/10.1016/S0140-6736(16)31257-0Wachter R, Gröschel K, Gelbrich G, Hamann G, Kermer P, Liman J, et al. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): an open-label randomised controlled trial. Lancet Neurol. 2017;16(4):282–290. https://doi.org/10.1016/S1474-4422(17)30002-9Wachter R, Gröschel K, Gelbrich G, Hamann G, Kermer P, Liman J, et al. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): an open-label randomised controlled trial. Lancet Neurol. 2017;16(4):282–290. https://doi.org/10.1016/S1474-4422(17)30002-9Jauch E, Saver J, Adams H, Bruno A, Connors J, Demaerschalk B, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association / American Stroke Association. Stroke. 2013;44(3):870–947. https://doi.org/10.1161/STR.0b013e318284056aJauch E, Saver J, Adams H, Bruno A, Connors J, Demaerschalk B, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association / American Stroke Association. Stroke. 2013;44(3):870–947. https://doi.org/10.1161/STR.0b013e318284056aNadarajah R, Wahab A, Reynolds C, Raveendra K, Askham D, Dawson R, et al. Future Innovations in Novel Detection for Atrial Fibrillation (FIND-AF): pilot study of an electronic health record machine learning algorithm-guided intervention to identify undiagnosed atrial fibrillation. Open Heart. 2023;10(2):e002447. https://doi.org/10.1136/openhrt-2023-002447Nadarajah R, Wahab A, Reynolds C, Raveendra K, Askham D, Dawson R, et al. Future Innovations in Novel Detection for Atrial Fibrillation (FIND-AF): pilot study of an electronic health record machine learning algorithm-guided intervention to identify undiagnosed atrial fibrillation. Open Heart. 2023;10(2):e002447. https://doi.org/10.1136/openhrt-2023-002447Rubio Campal J, García Torres M, Fernández de la Vara Prieto R, García Arribas D, Marín R, Almendro Delia M, et al. Detecting atrial fibrillation in patients with an embolic stroke of undetermined source (from the DAF-ESUS registry). Am J Cardiol. 2020;125(3):409–414. https://doi.org/10.1016/j.amjcard.2019.10.047Rubio Campal J, García Torres M, Fernández de la Vara Prieto R, García Arribas D, Marín R, Almendro Delia M, et al. Detecting atrial fibrillation in patients with an embolic stroke of undetermined source (from the DAF-ESUS registry). Am J Cardiol. 2020;125(3):409–414. https://doi.org/10.1016/j.amjcard.2019.10.047Ntaios G, Perlepe K, Lambrou D, Sirimarco G, Strambo D, Eskandari A, et al. Identification of patients with embolic stroke of undetermined source and low risk of new incident atrial fibrillation: the AF-ESUS score. Int J Stroke. 2021;16(1):29–38. https://doi.org/10.1177/1747493020925281Ntaios G, Perlepe K, Lambrou D, Sirimarco G, Strambo D, Eskandari A, et al. Identification of patients with embolic stroke of undetermined source and low risk of new incident atrial fibrillation: the AF-ESUS score. Int J Stroke. 2021;16(1):29–38. https://doi.org/10.1177/1747493020925281Li Y, Bisson A, Bodin A, Herbert J, Grammatico-Guillon L, Joung B, et al. C2 HEST score and prediction of incident atrial fibrillation in poststroke patients: a french nationwide study. J Am Heart Assoc. 2019;8(13):e012546. https://doi.org/10.1161/JAHA.119.012546Li Y, Bisson A, Bodin A, Herbert J, Grammatico-Guillon L, Joung B, et al. C2 HEST score and prediction of incident atrial fibrillation in poststroke patients: a french nationwide study. J Am Heart Assoc. 2019;8(13):e012546. https://doi.org/10.1161/JAHA.119.012546Pajareya P, Phutinart S, Siranart N, Paksin S, Jansem P, Anukoolwittaya P, et al. Natural courses of atrial fibrillation following cryptogenic stroke: a systematic review and meta-analysis. Indian Pacing Electrophysiol J. 2025;25(4):207–217. https://doi.org/10.1016/j.ipej.2025.06.006Pajareya P, Phutinart S, Siranart N, Paksin S, Jansem P, Anukoolwittaya P, et al. Natural courses of atrial fibrillation following cryptogenic stroke: a systematic review and meta-analysis. Indian Pacing Electrophysiol J. 2025;25(4):207–217. https://doi.org/10.1016/j.ipej.2025.06.006Ashburner J, Wang X, Li X, Khurshid S, Ko D, Trisini Lipsanopoulos A, et al. Re-CHARGE-AF: recalibration of the CHARGE-AF model for atrial fibrillation risk prediction in patients with acute stroke. J Am Heart Assoc. 2021;10(21):e022363. https://doi.org/10.1161/JAHA.121.022363Ashburner J, Wang X, Li X, Khurshid S, Ko D, Trisini Lipsanopoulos A, et al. Re-CHARGE-AF: recalibration of the CHARGE-AF model for atrial fibrillation risk prediction in patients with acute stroke. J Am Heart Assoc. 2021;10(21):e022363. https://doi.org/10.1161/JAHA.121.022363Hsieh C, Lee C, Sung S. Development of a novel score to predict newly diagnosed atrial fibrillation after ischemic stroke: the CHASE-LESS score. Atherosclerosis. 2020;295:1–7. https://doi.org/10.1016/j.atherosclerosis.2020.01.003Hsieh C, Lee C, Sung S. Development of a novel score to predict newly diagnosed atrial fibrillation after ischemic stroke: the CHASE-LESS score. Atherosclerosis. 2020;295:1–7. https://doi.org/10.1016/j.atherosclerosis.2020.01.003Ekizoglu E, Gezegen H, Ulusoy E, Tütüncü M, Demir T, Baykan B. CHADS 2 and CHA 2 DS 2 -VASc scores can guide the evaluation of cryptogenic ischemic stroke. Neurol India. 2021;69(6):1716–1721. https://doi.org/10.4103/0028-3886.333504Ekizoglu E, Gezegen H, Ulusoy E, Tütüncü M, Demir T, Baykan B. CHADS 2 and CHA 2 DS 2 -VASc scores can guide the evaluation of cryptogenic ischemic stroke. Neurol India. 2021;69(6):1716–1721. https://doi.org/10.4103/0028-3886.333504Кулеш А. А., Демин Д. А., Виноградов О. И. Криптогенный инсульт. Часть 1: аорто-артериальная эмболия. Медицинский совет. 2021;(4):78–87. https://doi.org/10.21518/2079-701X-2021-4-78-87Кулеш А. А., Демин Д. А., Виноградов О. И. Криптогенный инсульт. Часть 1: аорто-артериальная эмболия. Медицинский совет. 2021;(4):78–87. https://doi.org/10.21518/2079- 701X-2021-4-78-87 [Kulesh AA, Demin DA, Vinogradov OI. Cryptogenic stroke. Part 1: Aorto-arterial embolism. Meditsinskiy sovet = Medical Council. 2021;(4):78–87. (In Russ.) https://doi.org/10.21518/2079- 701X-2021-4-78-87]Cui X, Li Y, Liu J, He S, Liu M. Aortic arch atheroma and the risk of stroke: a meta-analysis. J Evid Based Med. 2014;7(3):185–191. https://doi.org/10.1111/jebm.12113Cui X, Li Y, Liu J, He S, Liu M. Aortic arch atheroma and the risk of stroke: a meta-analysis. J Evid Based Med. 2014;7(3):185–191. https://doi.org/10.1111/jebm.12113Amarenco P, Duyckaerts C, Tzourio C, Hénin D, Bousser M, Hauw J. The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med. 1992;326(4):221–225. https://doi.org/10.1056/NEJM199201233260402Amarenco P, Duyckaerts C, Tzourio C, Hénin D, Bousser M, Hauw J. The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med. 1992;326(4):221–225. https://doi.org/10.1056/NEJM199201233260402Ntaios G, Swaminathan B, Berkowitz S, Afzal M, Sirimarco G, Perlepe K, et al. Aortic arch atherosclerosis in patients with embolic stroke of undetermined source: an exploratory analysis of the NAVIGATE ESUS trial. Stroke. 2019;50(11):3184–3190. https://doi.org/10.1161/STROKEAHA.119.025813Ntaios G, Swaminathan B, Berkowitz S, Afzal M, Sirimarco G, Perlepe K, et al. Aortic arch atherosclerosis in patients with embolic stroke of undetermined source: an exploratory analysis of the NAVIGATE ESUS trial. Stroke. 2019;50(11):3184–3190. https://doi.org/10.1161/STROKEAHA.119.025813Harloff A, Dudler P, Frydrychowicz A, Strecker C, Stroh A, Geibel A, et al. Reliability of aortic MRI at 3 Tesla in patients with acute cryptogenic stroke. J Neurol Neurosurg Psychiatry. 2008;79(5):540–546. https://doi.org/10.1136/jnnp.2007.125211Harloff A, Dudler P, Frydrychowicz A, Strecker C, StrohA, Geibel A, et al. Reliability of aortic MRI at 3 Tesla in patients with acute cryptogenic stroke. J Neurol Neurosurg Psychiatry. 2008;79(5):540–546. https://doi.org/10.1136/jnnp.2007.125211Zhao X, Hippe DS, Li R, Canton GM, Sui B, Song Y, CARE II Study Collaborators, et al. Prevalence and characteristics of carotid artery high-risk atherosclerotic plaques in Chinese patients with cerebrovascular symptoms: a Chinese atherosclerosis risk evaluation II study. J Am Heart Assoc. 2017;6(8):e005831. https://doi.org/10.1161/JAHA.117.005831Zhao X, Hippe DS, Li R, Canton GM, Sui B, Song Y, CARE II Study Collaborators, et al. Prevalence and characteristics of carotid artery high-risk atherosclerotic plaques in Chinese patients with cerebrovascular symptoms: a Chinese atherosclerosis risk evaluation II study. J Am Heart Assoc. 2017;6(8):e005831. https://doi.org/10.1161/JAHA.117.005831Sannananja B, Zhu C, Mossa-Basha M. Vessel wall imaging in cryptogenic stroke. Radiol Clin North Am. 2023;61(3):491–500. https://doi.org/10.1016/j.rcl.2023.01.006Sannananja B, Zhu C, Mossa-Basha M. Vessel wall imaging in cryptogenic stroke. Radiol Clin North Am. 2023;61(3):491–500. https://doi.org/10.1016/j.rcl.2023.01.006Kamtchum-Tatuene J, Jickling G. Non-stenotic carotid plaques in embolic stroke of unknown source. Front Neurol. 2021;12:655674. https://doi.org/10.3389/fneur.2021.655674Kamtchum-Tatuene J, Jickling G. Non-stenotic carotid plaques in embolic stroke of unknown source. Front Neurol. 2021;12:655674. https://doi.org/10.3389/fneur.2021.655674Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet. 2014;383(9921):984–998. https://doi.org/10.1016/S0140-6736(13)61088-0Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet. 2014;383(9921):984–998. https://doi.org/10.1016/S0140-6736(13)61088-0Amarenco P. Underlying pathology of stroke of unknown cause (Cryptogenic Stroke). Cerebrovasc Dis. 2009;27(Suppl 1):97– 103. https://doi.org/10.1159/000200446Amarenco P. Underlying pathology of stroke of unknown cause (Cryptogenic Stroke). Cerebrovasc Dis. 2009;27(Suppl 1):97– 103. https://doi.org/10.1159/000200446Schaafsma J, Rawal S, Coutinho J, Rasheed A, Kooi M, Sacchetti D, et al. Diagnostic impact of intracranial vessel wall MRI in 205 patients with ischemic stroke or TIA. AJNR Am J Neuroradiol. 2019;40(10):1701–1706. https://doi.org/10.3174/ajnr.A6202Schaafsma J, Rawal S, Coutinho J, Rasheed A, Kooi M, Sacchetti D, et al. Diagnostic impact of intracranial vessel wall MRI in 205 patients with ischemic stroke or TIA. AJNR Am J Neuroradiol. 2019;40(10):1701–1706. https://doi.org/10.3174/ajnr.A6202Wang Y, Liu X, Wu X, Degnan A, Malhotra A, Zhu C. Culprit intracranial plaque without substantial stenosis in acute ischemic stroke on vessel wall MRI: a systematic review. Atherosclerosis. 2019;287:112–121. https://doi.org/10.1016/j.atherosclerosis.2019.06.907Wang Y, Liu X, Wu X, Degnan A, Malhotra A, Zhu C. Culprit intracranial plaque without substantial stenosis in acute ischemic stroke on vessel wall MRI: a systematic review. Atherosclerosis. 2019;287:112–121. https://doi.org/10.1016/j.atherosclerosis.2019.06.907

The authors declare that there are no conflicts of interest present.