Surgical interven- tion, including removal or occasionally valve replacement, is recommended for symptomatic fibroelastomas and for fibro- elastomas that are >1 cm in diameter or appear mobile, even if asymptomatic, because they pose a risk for embolism.501 Recommendations for the treatment of malignant cardiac neo- plasms depend on the precise nature and extent of the tumor and are beyond the scope of this document.502 Aortic Atherosclerosis Plaques 4 mm in size, particularly large, complex plaques, are associated with an increased risk of cryptogenic strokes.503 506 In the French Study of Aortic Plaques in Stroke, plaques >4 mm were found to be independent predictors of recurrent stroke Among patients with crypto- genic stroke who participated in PICSS, large plaques detected by transesophageal echocardiography were associated with an increased risk of recurrent ischemic stroke or death over a 2-year follow-up (HR, 6.42; 95% CI, 1.62 25.46), as were those with complex morphology (HR, 9.50; 95% CI, 1.92 47.10).504 Atheroembolism from aortic plaques is also a cause of stroke associated with cardiac surgery.505,506,508 There are no prospec- tive, randomized trials examining the efficacy of medical ther- apy to reduce the risk of stroke caused by embolic events from large thoracic aortic plaques. One nonrandomized study found that warfarin reduced the risk of recurrent stroke in patients with mobile thoracic atheroma detected by transesophageal echo- In another nonrandomized study, patients with aortic plaques >4 mm thick treated with oral anticoagulants had fewer stroke and peripheral embolic events than those treated with antiplatelet therapy.510 A retrospective analysis of patients with severe thoracic aortic plaque found that statin therapy (OR, 1.2) or antiplatelet therapy (OR, 1.4; 95% CI, 0.8 2.4), reduced the risk of stroke, TIA, and peripheral emboli.511 Other Cardiac Conditions: Summary and Gaps Cardiac conditions, including MI, cardiomyopathy, valvular heart disease, PFO and ASAs, cardiac tumors, and aortic ath- erosclerosis, are associated with an increased risk for stroke. 