Endovascular intervention for acute stroke due to infective endocarditis

Abstract

<jats:p>The overall incidence of neurological complications due to infective endocarditis is as high as 40%, with embolic infarcts more common than hemorrhagic strokes. The standard of care for typical strokes does not apply to infective endocarditis because there is a substantial risk of hemorrhage with thrombolysis. In the last decade there have been multiple case reports of intravenous and intraarterial thrombolysis with successful outcomes for acute strokes with related infective endocarditis, but successful endovascular interventions for acute strokes associated with infective endocarditis are rarely reported. To the authors' knowledge, this report is the first case in the literature to use a mechanical retrieval device in successful vegetation retrieval in an infective endocarditis acute stroke. Although an interventional approach for treatment of acute stroke related to infective endocarditis is a promising option, it is controversial and a cautious clinical decision should be made on a case-by-case basis. The authors conclude that this approach can be tested in a case series with matched controls, because this condition is rare and a randomized clinical trial is not a realistic option.</jats:p>

Thrombolysis for Ischemic Stroke Associated With Infective Endocarditis

“…3,4,8 The high rate is partly attributed to concurrent existence of mycotic aneurysms with subsequent rupture. Other potential pathogeneses include the presence of pyogenic arteritis, microabscesses, immune complex-mediated arteritis, and infiltration of meningeal vasculature.…”

“…[1][2][3][4][5] Patients with acute ischemic stroke (AIS) are treated with intravenous thrombolysis (IVT) within 4.5 hours of symptom onset as recommended by American Heart Association/American Stroke Association guidelines. 6 However, previous trials, including the National Institutes of Neurological Disorders and Stroke thrombolysis study and the Prolyse in Acute Cerebral Thromboembolism II trial, have excluded patients presenting with AIS associated with IE.…”

Intravenous thrombolysis is unsafe in stroke due to infective endocarditis

“…Endovascular treatment avoids the systemic effects of fibrinolysis and may be a safer option in patients with known IE. Two recent case reports describe the successful treatment of proximal middle cerebral artery occlusions because of septic embolism with clot retrieval devices …”

Infective Endocarditis Complicated by Acute Ischemic Stroke from Septic Embolus: Successful Solitaire FR Thrombectomy

“…The first report described a 33-year-old man with IE and septic embolism causing an acute M1 occlusion which was also successfully revascularized [1]. There has also been one case of successful retrieval of a septic embolus using the Penumbra aspiration system described in the literature [2]. …”