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The term “embolic” was first suggested in 1854 by Virchow1 when he described a patient with occlusion of the brain arteries by clots that appeared to arise from the heart. All currently available evidence suggests that the majority of ischemic strokes are of an embolic nature.2
The identification of the cause of ischemic stroke is a 2-step process. Initially, an ischemic stroke is classified on a pathophysiologic basis, with the 2 main pathophysiologic mechanisms being embolism and small-vessel disease (Figure). The next step is to classify it further on an etiologic basis.