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Despite the unquestionable superiority of Transesophageal echocardiography (TEE) over Transthoracic echocardiography (TTE), the impact of TEE on the long term management of cardio-embolic strokes remains uncertain. The purpose of present study was to determine the extent to which TEE, influenced the decision regarding long-term anticoagulant management of patients with ischemic stroke in a University Hospital. Between January 1992 and May 1995, TEE was performed in 122 out of 485 consecutive patients with ischemic stroke enrolled in the Maryland Stroke Data Bank. The indication to perform TEE was unexplained cerebral infarction. Twenty five patients had a possible cardiac source of embolism (CSOE) detected only after a TEE out of whom 17 were placed on anticoagulant therapy. From the remaining 8 patients, 2 expired, 2 were already receiving anticoagulants for different reasons and 4 were managed with antiplatelet agents. To conclude, in 17 of 122 ischemic stroke patients (14%) who underwent TEE, the decision regarding long term anticoagulation was made only because TEE revealed a cardioembolic source.