How do you treat patients with stroke thought to be secondary to Lambl excrescence?

Pathophysiologically, these occur through sheer stress to the valvular endocardium causing small areas to be denuded followed by fibrin deposition and microthrombi formation on the endocardial injury, which can embolize. Histopathologically, they have similarities to fibroelastomas (which are larger...

The definitive treatment is surgical removal. If that is not possible, then I would try anticoagulation, but without much evidence of efficacy.