Myxoma is the most common cardiac tumor, and the majority of them occur in the left atrium.498 About 30% to 40% of myxomas Stroke or TIA is the presenting symptoms in half of the patients with papillary fibroelastomas.500 Surgical exci- sion of atrial myxomas is recommended. 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. 