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Concurrent bacterial endocarditis is associated with worse inpatient outcomes for large vessel occlusions

Ian A Ramsay1, Turki Elarjani2, Vaidya Govindarajan2

  • 1MD-MPH Program, University of Miami Miller School of Medicine, Miami, Florida, USA ian.ramsay@med.miami.edu.

Journal of Neurointerventional Surgery
|August 16, 2023
PubMed

Insights

Mechanical thrombectomy for acute ischemic stroke in bacterial endocarditis patients shows higher mortality and complication rates compared to stroke-only patients. Further research is needed to improve outcomes for this vulnerable population.

Area of Science:

  • Neurology
  • Cardiology
  • Interventional Neuroradiology

Background:

  • Bacterial endocarditis frequently causes neurological complications, including acute ischemic stroke (AIS).
  • Mechanical thrombectomy (MT) is effective for large vessel occlusion (LVO) stroke, but data on its use in endocarditis patients are limited.

Purpose of the Study:

  • To assess the outcomes of mechanical thrombectomy for large vessel occlusion strokes in patients with concurrent bacterial endocarditis.

Main Methods:

  • Utilized the National Inpatient Sample (NIS) database from October 2015 to 2019.
  • Identified patients receiving MT for LVO of the middle cerebral artery.
  • Calculated odds ratios using multivariate logistic regression.

Main Results:

  • Compared to 57,420 AIS-only patients, 635 AIS with BE patients undergoing MT had significantly higher mortality (26.8% vs 10.2%) and lower rates of routine discharge (10.2% vs 20.9%).
  • AIS with BE patients had increased odds of death (OR 3.94), lower odds of routine discharge (OR 0.23), and higher rates of post-treatment cerebral hemorrhage (39.4% vs 23.7%).
  • Higher odds of other complications like hydrocephalus, respiratory failure, acute kidney injury, and sepsis were observed in AIS with BE patients.

Conclusions:

  • Mechanical thrombectomy is feasible for endocarditis patients with LVO strokes but associated with worse clinical outcomes.
  • Further research is warranted to elucidate the clinical course and develop improved treatments for stroke in endocarditis patients.
Abstract

Keywords:
StrokeThrombectomy

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