Cardioembolic Stroke: Concepts and Controversies

Abstract

The concept of thrombotic fragments detaching from the heart and migrating to occlude distal arteries has been recognized for more than a century. In 1828, Allibert repcrted blockage of a femoral artery by a coagulum similar to one found in the left atrial appendage (1). In 1847, Virchow described occlusion of cerebral arteries by thrombi that appeared to arise in the heart (2). Virchow later termed this phenomena embolism, derived from the Greek word for plug. In 1852, Kirkes reported a patient whose middle cerebral artery was plugged by a “firm, oval mass about the size and shape of a grain of wheat… the mitral valve was much diseased, the auricular surface beset with large warty excrescenses” (3).