One in six ischaemic stroke patients has an embolic stroke of undetermined source (ESUS), defined as a stroke with unclear aetiology despite recommended diagnostic evaluation. The overall cardiovascular risk of ESUS is high and it is important to optimize strategies to prevent recurrent stroke and other cardiovascular events. The aim of clinicians when confronted with a patient not only with ESUS but also with any other medical condition of unclear aetiology is to identify the actual cause amongst a list of potential differential diagnoses, in order to optimize secondary prevention. However, specifically in ESUS, this may be challenging as multiple potential thromboembolic sources frequently coexist. Also, it can be delusively reassuring because despite the implementation of specific treatments for the individual pathology presumed to be the actual thromboembolic source, patients can still be vulnerable to stroke and other cardiovascular events caused by other pathologies already identified during the index diagnostic evaluation but whose thromboembolic potential was underestimated. Therefore, rather than trying to presume which particular mechanism is the actual embolic source in an ESUS patient, it is important to assess the overall thromboembolic risk of the patient through synthesis of the individual risks linked to all pathologies present, regardless if presumed causally associated or not. In this paper, a multi-disciplinary panel of clinicians/researchers from various backgrounds of expertise and specialties (cardiology, internal medicine, neurology, radiology and vascular surgery) proposes a comprehensive multi-dimensional assessment of the overall thromboembolic risk in ESUS patients through the composition of individual risks associated with all prevalent pathologies.

中文翻译：

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来源不明的栓塞性中风：ESC 中风理事会、欧洲心血管影像协会和 ESC 欧洲心律协会的临床共识声明

六分之一的缺血性中风患者患有不明原因栓塞性中风 (ESUS)，其定义为尽管建议进行诊断评估，但病因仍不清楚的中风。 ESUS 的总体心血管风险很高，优化预防卒中复发和其他心血管事件的策略非常重要。临床医生在面对不仅患有 ESUS 而且还患有任何其他病因不明的医疗状况的患者时，其目的是在一系列潜在的鉴别诊断中确定实际原因，以优化二级预防。然而，特别是在 ESUS 中，这可能具有挑战性，因为多种潜在的血栓栓塞来源经常共存。此外，它可能会令人产生错觉，因为尽管对被认为是实际血栓栓塞来源的个体病理实施了特定治疗，但患者仍然容易遭受中风和其他心血管事件，这些疾病是由指数诊断评估期间已识别的其他病理引起的，但其血栓栓塞的可能性被低估了。因此，重要的是通过综合与存在的所有病理相关的个体风险来评估患者的总体血栓栓塞风险，而不是试图推测哪种特定机制是 ESUS 患者的实际栓塞来源，无论是否假定因果关系或不是。在本文中，来自不同专业背景（心脏病学、内科、神经病学、放射学和血管外科）的临床医生/研究人员组成的多学科小组提出了对 ESUS 患者整体血栓栓塞风险的全面多维评估，方法是：与所有流行病状相关的个体风险的构成。