Efficacy and Safety of Mechanical Thrombectomy in Acute Ischemic Stroke Secondary to Infective Endocarditis
Objectives: Acute ischaemic strokes (stroke) are frequent and severe extracardiac complications in infective endocarditis (IE). Because intravenous thrombolysis (i.v.-thrombolysis) is contraindicated, mechanical thrombectomy (thrombectomy) offers potential benefits. We aimed to compare thrombectomy...
| Autores: | , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión aceptada para publicación |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Repositorio: | Recercat. Dipósit de la Recerca de Catalunya |
| OAI Identifier: | oai:recercat.cat:2445/226367 |
| Acceso en línea: | https://hdl.handle.net/2445/226367 |
| Access Level: | acceso abierto |
| Palabra clave: | Endocarditis Embòlia i trombosi cerebral Complicacions (Medicina) Cerebral embolism and thrombosis Complications (Medicine) |
| Sumario: | Objectives: Acute ischaemic strokes (stroke) are frequent and severe extracardiac complications in infective endocarditis (IE). Because intravenous thrombolysis (i.v.-thrombolysis) is contraindicated, mechanical thrombectomy (thrombectomy) offers potential benefits. We aimed to compare thrombectomy efficacy and safety between IE-related and general stroke cases. Methods: Multicentre study of consecutive IE cases treated with thrombectomy at nine stroke centres in Spain from 2011 to 2022. Using propensity score matching, 50 IE cases were 1:4 matched with patients without IE stroke (n = 200). Efficacy was defined by successful recanalization rates (modified treatment in cerebral ischaemia scale ≥2 b), neurological improvement at 24 hours (decrease of National Institutes of Health Stroke Scale compared with baseline), and good neurological outcome rates at 3 months (modified Rankin scale ≤2). Safety was assessed by intracranial haemorrhage (IC-haemorrhage), symptomatic IC-haemorrhage, crude mortality, and stroke-related mortality. Results: Among 54 IE cases, 50 were matched with 200 controls. Successful recanalization was similarly achieved in both groups (76% vs. 83%). Median National Institutes of Health Stroke Scale at 24 hours was comparable, with analogous rates of neurological improvement (78% vs. 78%), and early dramatic response (48% vs. 46.5%). No differences were seen regarding IC-haemorrhage rates, except for when prior i.v.-thrombolysis was given. Although crude mortality was higher in the IE cohort, no differences were seen in stroke-related mortality (12% vs. 15%). At 3 months, modified Rankin scale scores of the two groups were superimposable. Discussion: Thrombectomy in IE is as effective and safe as in patients without IE, and prior i.v.-thrombolysis could decrease the procedural safety. Clinical practice guidelines may consider including the recommendation to perform thrombectomy alone in IE-related stroke. |
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