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SummaryBackground Transesophageal echocardiography (TEE) has been used to identify the potential risk forcardiogenic embolism in patients with atrial fibrillation (AF). However, ischemic stroke in patients with AF is not always attributable to embolism. Identification of the risk of embolic versus atherothrombotic stroke should lead to the optimal individualized management of patients with AF.Hypothesis: The goal ofthe study was to determine the relation between cortical infarction and perforating infarction and TEE findings in patients with AF.A4ethod.s: We investigated the clinical usefulness of TEE in the risk stratification of clinical subtyping of the cerebral infarctions which were divided into two temtories of the cortical branch (cortical infarction due to embolism) and deep perforators (perforating infarction due to atherothrombosis). Left atrial spontaneous echo contrast, peak flow velocity in the left atrial appendage, and generalized atherosclerosis as estimated by the intima-media wall thickness of the thoracic aorta were assessed by TEE in 118 consecutive patients with either paroxysmal (n = 44) or chronic (n = 74) AF. All patients un-

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