In patients with major isch- emic stroke or intracranial hemorrhage, it is reasonable to delay valve surgery for at least 4 weeks. Recommendations 1. Valve surgery may be considered in IE patients with stroke or subclinical cerebral emboli and residual vegetation without delay if intracranial hemorrhage has been excluded by imaging studies and neurolog- ical damage is not severe (ie, coma) (Class IIb; Level of Evidence B). 2. In patients with major ischemic stroke or intra- cranial hemorrhage, it is reasonable to delay valve surgery for at least 4 weeks (Class IIa; Level of Evidence B). Risk of Embolization Systemic embolization occurs in 22% to 50% of cases of Rates can be higher if noninvasive imaging, including MRI and CT scanning, is routinely done to detect asymptomatic (silent) emboli. Emboli often involve major arterial beds, including the brain, lungs, coronary arteries, spleen, bowel, and extremities. Up to 65% of embolic events involve the CNS, and >90% of CNS emboli lodge in the distri- bution of the middle cerebral artery.277 The highest incidence of embolic complications is seen with mitral valve IE (and more with anterior rather than posterior mitral leaflet involve- ment) and with IE caused by S aureus, Candida, and HACEK organisms. Emboli can occur before diagnosis, during therapy, or after therapy is completed, although most emboli occur within the first 2 to 4 weeks of antimicrobial therapy.58,278 Of note, 2 inde- pendent studies have confirmed that the rate of embolic events decreases dramatically during and after the first 2 to 3 weeks of successful antibiotic therapy. In a study from 1991, the embolic rate dropped from 13 to <1.2 embolic events per 1000 patient-days during that time.58 Vilacosta et al278 confirmed the reduced frequency of embolization after 2 weeks of therapy. 