Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: A case–control study

Abstract

Background and purpose Successful reperfusion can be achieved in more than two-thirds of patients with usual large-vessel occlusion stroke causes treated with mechanical thrombectomy. However, the safety and outcomes after mechanical thrombectomy in the setting of large-vessel occlusion related to infective endocarditis is not known. In this study, we investigated the impact of mechanical thrombectomy in infective endocarditis patients on angiographic and clinical outcomes. Methods This was a multicenter study from five comprehensive stroke centers. We compared the outcomes of mechanical thrombectomy treated stroke patients due to infective endocarditis with patients presenting atrial fibrillation. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage, and mortality. Results Between June 2013 and March 2019, 28 patients presenting large-vessel occlusion stroke due to IE were included. These cases were matched with 84 large-vessel occlusion stroke related to atrial fibrillation. Successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) was obtained in 85.7%. Symptomatic intracranial hemorrhage, favorable outcome and mortality rates were respectively 8.0%, 25.9%, and 25.9%. In the case–control analysis, we demonstrated no difference in terms of successful reperfusion, procedural complication, symptomatic intracranial hemorrhage, and mortality rates. Three-month favorable outcome was less often achieved in the infective endocarditis group. Conclusions Mechanical thrombectomy of infective endocarditis patients presents similar safety and angiographic results compared to patients suffering from atrial fibrillation.

Safety and efficacy of mechanical thrombectomy in infective endocarditis: A matched case–control analysis from the German Stroke Registry–Endovascular Treatment

“…Periprocedural time management, especially regarding admission to groin, was delayed for 27 min in infective endocarditis patients in the current study. This is in contrast to the previous study, in which procedural time showed no differences, especially also regarding the time until the decision for MT was made [9]. The reason for this time delay remains speculative.…”

“…In the further management of MT, time management no longer differed regarding, for example, groin to first passage or groin to flow restoration. Similar findings regarding periprocedural time management with no differences during the intervention were reported elsewhere [9].…”

“…These results are in contrast to a study analyzing 28 patients with infective endocarditis compared to 84 patients with LVO due to AF in a 1:3 ratio in which MT in infective endocarditis presented with similar safety and successful reperfusion rates (85.7% vs. 95.2%, p = 0.11) [9]. Other case series also reported good efficacy of MT in septic embolism stroke [4,12,13].…”

“…On the other hand, a systematic review recently described 52 patients with stroke due to infective endocarditis who showed a higher risk of ICH: 4.1 times higher under IVT treatment and 4.7 times higher under IVT combined with MT [4]. The largest study sample of 28 consecutive patients with infective endocarditis presenting with LVO showed no difference in terms of successful reperfusion, procedural complications, occurrence of any hemorrhagic complication (ICH, symptomatic ICH [sICH], and parenchymal hematoma [PH]), and mortality compared to 84 matched cases with cardioembolic stroke due to atrial fibrillation (AF) [9]. However, favorable outcome at follow‐up was less often observed in the infective endocarditis group without reaching significance.…”

“…However, favorable outcome at follow‐up was less often observed in the infective endocarditis group without reaching significance. Stroke recurrence rate was higher among infective endocarditis patients, up to 25.0% [9]. Therefore, the optimal therapy for acute ischemic LVO stroke due to septic embolism in infective endocarditis so far remains a matter of debate.…”