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Updated: Jan 23, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Catastrophic Multiple Microbleeds Caused by Infective Endocarditis Following Intravenous Thrombolysis and
Ryosuke Maeoka1, Ichiro Nakagawa2, Hiroyuki Ohnishi1
1Department of Neurosurgery, Ohnishi Neurological Center, Hyogo, Japan.
Insights
Infective endocarditis (IE) can cause acute ischemic stroke (AIS) with large vessel occlusion. Early IE diagnosis is challenging, and intravenous thrombolysis for AIS due to IE is controversial due to hemorrhage risks.
Area of Science:
- Neurology
- Cardiology
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a significant cause of ischemic stroke, particularly those involving emergent large vessel occlusion (ELVO).
- Early diagnosis of IE in patients presenting with acute ischemic stroke (AIS) is often difficult.
- Standard treatment for AIS with ELVO includes endovascular thrombectomy (EVT), potentially with intravenous thrombolysis (IVT).
Abstract:
Ischemic stroke is one of the most common complications of infective endocarditis (IE). IE must be considered as one of the causes of acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO), but early diagnosis of IE is difficult. AIS with ELVO must be treated using endovascular thrombectomy (EVT), with or without intravenous thrombolysis (IVT). IVT for AIS due to IE is not well established and remains controversial because of the risk of intracranial hemorrhage. A 42-year-old man suffered from right hemiparesis and disorientation, and AIS with ELVO was diagnosed. EVT with IVT was successfully performed and recanalization was achieved, but catastrophic multiple cerebral microbleeds appeared after treatment. EVT without IVT could be chosen for AIS caused by IE to avoid hemorrhagic complications. Hypointense signal spots on T2*-weighted magnetic resonance imaging (MRI) and susceptibility-weighted MRI could facilitate early diagnosis of IE.
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