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2025-02-07

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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/226367

Efficacy and Safety of Mechanical Thrombectomy in Acute Ischemic Stroke Secondary to Infective Endocarditis

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https://doi.org/10.1016/j.cmi.2025.02.008

Resum

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.

Matèries

Endocarditis, Embòlia i trombosi cerebral, Complicacions (Medicina)

Matèries (anglès)

Endocarditis, Cerebral embolism and thrombosis, Complications (Medicine)

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Col·leccions

Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

Citació

LAPEÑA, Pau, URRA, Xabier, LLOPIS, Jaume, HERNÁNDEZ-MENESES, Marta, CUERVO REQUENA, Guillermo, MAISTERRA, Olga, ESCRIHUELA VIDAL, Francesc, PRATS-SÁNCHEZ, Luis, SÁEZ, Carmen, OLMOS, Carmen, HERNÁNDEZ-FERNÁNDEZ, Francisco, WERNER, Mariano, PÉREZ DE LA OSSA, Natalia, QUINTANA, Eduard, MORENO CAMACHO, Ma. asunción, CHAMORRO SÁNCHEZ, Ángel, MIRÓ MEDA, José m. (josé maría), Mechanical Thrombectomy in IE Investigators, Cat-SCR Consortium. Efficacy and Safety of Mechanical Thrombectomy in Acute Ischemic Stroke Secondary to Infective Endocarditis. _Clinical Microbiology and Infection_. 2025. Vol. 31, núm. 8, pàgs. 1321-1329. [consulta: 20 de febrer de 2026]. ISSN: 1198-743X. [Disponible a: https://hdl.handle.net/2445/226367]

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