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When the ESUS concept was introduced, covert atrial fibrillation was conceived to be the main underlying cause in the majority of ESUS patients. Another important embolic source in ESUS is the atherosclerotic plaque in the carotid, vertebrobasilar, and intracranial arteries, or the aortic arch\u2014collectively described as supracardiac atherosclerosis. There is emerging evidence showing that the role of supracardiac atherosclerosis is larger than it was initially perceived. Advanced imaging methods are available to identify plaques which high embolic risk. The role of novel antithrombotic strategies in these patients needs to be assessed in randomized controlled trials. This review presents the evidence which points towards a major aetiological association between atherosclerotic plaques and ESUS, summarizes the imaging features which may aid to identify plaques more likely to be associated with ESUS, discusses strategies to reduce the associated stroke risk, and highlights the rationale for future research in this field.<\/jats:p>\n                  <jats:p\/>","DOI":"10.1093\/eurheartj\/ehaa218","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T16:32:15Z","timestamp":1584030735000},"page":"1789-1796","source":"Crossref","is-referenced-by-count":50,"title":["Supracardiac atherosclerosis in embolic stroke of undetermined source: the underestimated source"],"prefix":"10.1093","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0629-9248","authenticated-orcid":false,"given":"George","family":"Ntaios","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly , Biopolis, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Wintermark","sequence":"additional","affiliation":[{"name":"Department of Radiology, Neuroradiology Section, Stanford University and Medical Center , 300 Pasteur Drive, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4954-7579","authenticated-orcid":false,"given":"Patrik","family":"Michel","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital , Rue du Bugnon 46, Lausanne CH-1011, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,16]]},"reference":[{"key":"2022102507271798600_ehaa218-B1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","article-title":"Classification of subtype of acute ischemic stroke. 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