Infective Endocarditis-Associated Cerebral Embolism With Successful Early Thrombectomy Followed by Subarachnoid...

Infective endocarditis (IE)-associated cerebral embolism can lead to severe complications, including subarachnoid hemorrhage (SAH). Inflammation spreading from the embolus to the arterial wall may cause vascular fragility, increasing the risk of hemorrhage even after successful recanalization. Furthermore, mechanical stress during thrombectomy may intensify this fragility, potentially precipitating hemorrhage. However, the timing of the onset of these hemorrhagic complications remains unclear. We report a 71-year-old man with IE who presented with sudden consciousness disturbance three months after discharge from antibiotic therapy. Imaging revealed left middle cerebral artery (MCA) occlusion with early ischemic changes. Thrombectomy was performed at three hours and 40 minutes after onset, achieving complete recanalization (expanded Thrombolysis in Cerebral Infarction, or eTICI 3). His neurological status initially improved, but six hours after surgery, he exhibited recurrent consciousness disturbance. A computed tomography (CT) scan revealed SAH in the left Sylvian fissure. No vascular anomalies or procedural complications were noted. This delayed event was likely due to a combination of vascular fragility from IE, inflammation spreading from the embolus, and mechanical stress from the procedure. Even with early and atraumatic recanalization, careful postoperative monitoring is essential.