Intravenous thrombolysis is unsafe in stroke due to infective endocarditis

Brownlee, WJ; Anderson, N. E.; Barber, P. Alan

doi:10.1111/imj.12343

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…In the milieu of septic embolisation, IV-tPA has been reported to be associated with increased risk of bleeding and poor lytic efficacyhence increased probability of poor angiographic and clinical outcomes. 5,16 Consistent with the predominance of RBCs interspersed within fibrin bands in our retrieved clots, we found prominent early imaging signs such as the hyperdense middle cerebral artery (HDMCA) sign on NCCT in all four cases. Other studies have also reported a correlation between these early imaging signs with the density of RBCs in the retrieved thrombi of non-IE-related cases.…”

Section: Discussionsupporting

confidence: 81%

Clot Histopathology in Ischemic Stroke with Infective Endocarditis

Bhaskar

Saab

Cappelen‐Smith

et al. 2019

Can. J. Neurol. Sci.

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ABSTRACT:Background: Endovascular thrombectomy (EVT) has shown efficacy in acute ischemic stroke (AIS) patients with infective endocarditis (IE). The possibility to undertake advanced histopathological clot analysis following EVT offers a new avenue to establish the etiological basis of the stroke – which is often labelled “cryptogenic.” In this paper, we present our findings from four consecutive patients with IE who underwent EVT following an AIS at our tertiary referral comprehensive stroke centre. Methods: Comprehensive histopathological analysis of clot retrieved after EVT, including morphology, was undertaken. Results: The consistent observation was the presence of dense paucicellular fibrinoid material mixed/interspersed with clusters of bacterial cocci. This clot morphology may be specific to septic embolus due to IE unlike incidental bacteraemia and could possibly explain the refractoriness of such clots to systemic thrombolysis. Conclusion: Detailed morphological and histopathological analysis of EVT-retrieved clots including Gram staining can assist in etiological classification of the clot. Understanding the composition of the clot may be of clinical value in early diagnostics and mapping treatment planning in IE.

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Section: Discussionsupporting

confidence: 81%

Clot Histopathology in Ischemic Stroke with Infective Endocarditis

Bhaskar

Saab

Cappelen‐Smith

et al. 2019

Can. J. Neurol. Sci.

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“…There are concerns about the safety and efficacy of IV‐tPA in the setting of septic emboli . Known endocarditis is a contraindication to IV‐tPA primarily due to concerns about bleeding risk .…”

Section: Discussionmentioning

confidence: 78%

Clarion call for histopathological clot analysis in “cryptogenic” ischemic stroke: implications for diagnosis and treatment

Bhaskar

Cordato

Cappelen‐Smith

et al. 2017

Ann Clin Transl Neurol

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Diagnosis, treatment, and secondary management of cryptogenic stroke patients pose a formidable challenge. The scenario is further complicated in patients with native and prosthetic valvular heart disease. We present a case study of a 36‐year‐old man who received intravenous thrombolysis (IV‐tPA) and endovascular thrombectomy (EVT) for presumed “cryptogenic” complete middle cerebral artery infarction who made a surprisingly excellent clinical recovery despite poor baseline and postintervention neuroimaging. Retrospective gram stain of his clot confirmed a diagnosis of infective endocarditis. This raises an important issue regarding need for more routine histopathological analysis of clot retrieved after EVT in “cryptogenic” stroke patients particularly those with valvular heart disease.

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“…Moreover, few cases occurred symptomatic intracranial hemorrhages [3]. On the other hand intravenous tissue plasminogen activator is high risk of the complication of intracerebral hemorrhage [3][4][5][6]. Anotheris the pathology of the retrieved thrombus leads to definitive diagnosis for embolic stroke of unknown origin [7].…”

Section: Discussionmentioning

confidence: 99%

A Case of Middle Cerebral Artery Occlusion Due to Thrombus with Bacterial Colony

Kuriyama¹

2020

BJSTR

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Diagnosis and treatment for embolic stroke due to Infective Endocarditis (IE) is the challenging. We describe the case of acute middle cerebral artery occlusion with fever and inflammation underwent Mechanical Thrombectomy (MT) and retrieved atypical thrombus. That pathological finding, thrombus with bacterial colony, proved the diagnosis of IE. Following appropriate antibiotic therapy and replacement of the cardiac valve, the clinical outcome was favorable. Given this case experience and other reported cases, MT may be considered as a prime option for acute ischemic large-vessel occlusion due to IE.

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Intravenous thrombolysis is unsafe in stroke due to infective endocarditis

Cited by 13 publications

References 11 publications

Clot Histopathology in Ischemic Stroke with Infective Endocarditis

Clot Histopathology in Ischemic Stroke with Infective Endocarditis

Clarion call for histopathological clot analysis in “cryptogenic” ischemic stroke: implications for diagnosis and treatment

A Case of Middle Cerebral Artery Occlusion Due to Thrombus with Bacterial Colony

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