Mechanical Thrombectomy in Stroke from Infective Endocarditis: Case Report and Review

Abstract

Objective: To characterize outcomes after mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) from infective endocarditis.

Methods: Case report and review of published cases.

Results: We report the case of a 59-year-old woman with fungal endocarditis who developed AIS from a proximal middle cerebral artery (MCA) embolus. She underwent MT, with good outcome. An additional 25 similar cases were identified from 14 publications. Among the 26 cases analyzed (mean [SD] age, 55 [18.7] years, 42% women), the MCA was the most common site of arterial occlusion. Four patients received intravenous tissue plasminogen activator treatment before MT. The median admission NIH Stroke Scale score (NIHSSS) was 15.5 [interquartile range 9.75-19.25] and the median post-procedure NIHSSS was 2 [interquartile range .75-6]. No patient developed symptomatic intracerebral hemorrhage.

Conclusions: MT appears to be a safe and effective therapeutic option in infective endocarditis-related AIS with proximal-artery occlusion.

Keywords: Stroke; endocarditis; infection; mechanical thrombectomy.