{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T04:57:19Z","timestamp":1766120239780,"version":"3.48.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,11,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Identifying the potential cause of embolic stroke of undetermined source is essential for secondary prevention. We analyzed retrospectively collected real\u2010world data from the South Korean cohort with embolic stroke of undetermined source to examine trends in baseline characteristics, diagnostic practices, and secondary prevention strategies and to identify cardioembolic factors and supracardiac atherosclerotic lesions associated with stroke recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed 5787 patients from the Real\u2010World Study of Embolic Stroke of Undetermined Source cohort from 19 South Korean stroke centers (2014\u20132019). Baseline characteristics, diagnostic and secondary prevention trends were evaluated. Factors associated with 1\u2010year stroke recurrence were identified using multivariable Cox regression analysis in 4036 patients with follow\u2010up data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Over 6\u2009years, vascular risk factors and cardioembolic evaluations significantly increased. Stroke recurrence was strongly associated with intracranial nonrelevant stenosis involving \u22652 vessels (hazard ratio [HR], 2.756,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), paroxysmal atrial fibrillation (HR, 5.590,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.033), atrial septal aneurysm (HR, 4.741,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.005), and serum creatinine levels (HR, 1.166,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.008). In patients without moderate\u2010risk cardioembolic sources, a single intracranial nonrelevant stenosis and complex aortic atheroma were also linked to stroke recurrence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Intracranial nonrelevant stenosis and complex aortic atheroma, along with cardioembolic factors like paroxysmal atrial fibrillation and atrial septal aneurysm, are key predictors of stroke recurrence in embolic stroke of undetermined source, especially those without moderate\u2010risk cardioembolic sources. These findings emphasize the need to consider both supracardiac atherosclerotic and cardioembolic mechanisms in embolic stroke of undetermined source and to develop tailored secondary prevention strategies for atherosclerotic stroke, particularly in cases with supracardiac atherosclerotic lesions to reduce stroke recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.042812","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T06:14:36Z","timestamp":1762928076000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Supracardiac Atherosclerotic Lesions in Embolic Stroke of Undetermined Source: Predicting Stroke Recurrence and Enhancing Secondary Prevention Strategies"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7518-9739","authenticated-orcid":false,"given":"Hyung Jun","family":"Kim","sequence":"first","affiliation":[{"name":"Samsung Medical Center, Sungkyunkwan University School of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0468-6738","authenticated-orcid":false,"given":"Hyun Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Samsung Medical Center, Sungkyunkwan University School of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6733-0683","authenticated-orcid":false,"given":"Jang\u2010Hyun","family":"Baek","sequence":"additional","affiliation":[{"name":"Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9591-4005","authenticated-orcid":false,"given":"Hahn Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Konkuk University School of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6665-7481","authenticated-orcid":false,"given":"Yang\u2010Ha","family":"Hwang","sequence":"additional","affiliation":[{"name":"Kyungpook National University of Medicine and Hospital","place":["Daegu, South Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9215-5119","authenticated-orcid":false,"given":"Sung Hyuk","family":"Heo","sequence":"additional","affiliation":[{"name":"Kyung Hee University Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6489-0100","authenticated-orcid":false,"given":"Ho Geol","family":"Woo","sequence":"additional","affiliation":[{"name":"Kyung Hee University Medical 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Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin\u2010Man","family":"Jung","sequence":"additional","affiliation":[{"name":"Korea University Ansan Hospital, Korea University College of Medicine","place":["Ansan, South Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9538-446X","authenticated-orcid":false,"given":"Sang\u2010Hun","family":"Lee","sequence":"additional","affiliation":[{"name":"Korea University Ansan Hospital, Korea University College of Medicine","place":["Ansan, South Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1049-5196","authenticated-orcid":false,"given":"Jae\u2010Kwan","family":"Cha","sequence":"additional","affiliation":[{"name":"Dong\u2010A University Hospital","place":["Busan, Republic of 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