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Updated: Jul 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Stroke-Associated Infections after Mechanical Thrombectomy: Analysis of the Stroke-Associated INfection afTer
Charles Berman1, Andy Vail2, Ioana Iancu3
1Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Introduction:
Despite the established benefit of mechanical thrombectomy (MT), data on the incidence, risk factors, and longer-term outcomes of stroke-associated infections (SAIs) in this population remain limited. This retrospective, single-centre cohort study evaluated the frequency of SAI, associated variables, and longer-term mortality post-MT.
Methods:
Data for acute ischaemic stroke patients undergoing MT at Manchester Centre for Clinical Neurosciences were extracted from the Sentinel Stroke National Audit Programme (April 2016-March 2024) and linked to electronic patient records. Routinely collected admission and procedural variables were analysed. Primary outcome measures were the proportion of patients developing SAI and subtypes of SAI post-MT. Multifactorial regression analysis was performed to evaluate associations between clinical variables and SAI and also between SAI and 1-year mortality.
Results:
Of 589 patients, 179 (30%) developed SAI. Stroke-associated pneumonia (SAP) accounted for 73% of SAI (131 cases, 22% of patients); urinary tract infections comprised 9%. Admission NIHSS, dysphagia, C-reactive protein (CRP), neutrophil-lymphocyte ratio, and premorbid mRS were independently associated with SAI (p < 0.05). Similar associations were observed for SAP, though CRP association was attenuated. Crude 1-year mortality was higher in patients with SAI (34%, 60/179), including those with SAP (36%, 47/131), compared with 12% (49/410) in non-SAI patients. However, multivariable regression did not reach statistical significance.
Conclusions:
SAI occurred in nearly one-third of patients post-MT, predominantly as SAP. While crude mortality was increased with SAI, adjusted analyses were non-significant. Several variables were independently associated with SAI, enabling opportunities for identification of high-risk patients for enhanced monitoring or preventive strategies.
Insights
Nearly one-third of patients undergoing mechanical thrombectomy (MT) developed stroke-associated infections (SAIs), primarily stroke-associated pneumonia (SAP). While SAIs increased crude mortality, adjusted analyses were not significant, highlighting potential for early risk identification.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Medicine
Background:
- Mechanical thrombectomy (MT) is a key treatment for acute ischemic stroke.
- Data on stroke-associated infections (SAIs) following MT, including incidence, risk factors, and long-term outcomes, are limited.
- Understanding SAI epidemiology post-MT is crucial for improving patient management.
Purpose of the Study:
- To determine the incidence and types of SAIs in patients undergoing MT.
- To identify clinical variables associated with SAI development post-MT.
- To evaluate the association between SAIs and 1-year mortality after MT.
Main Methods:
- Retrospective cohort study of acute ischemic stroke patients undergoing MT.
- Data extracted from Sentinel Stroke National Audit Programme and Electronic Patient Records (April 2016-March 2024).
- Multifactorial regression analysis used to assess associations with SAI and 1-year mortality.
Main Results:
- 179 out of 589 patients (30%) developed SAI, with stroke-associated pneumonia (SAP) being the most common (22%).
- Independent predictors of SAI included admission NIHSS, dysphagia, CRP, neutrophil-lymphocyte ratio, and premorbid mRS.
- Crude 1-year mortality was higher in patients with SAI (34%) compared to those without (12%), but adjusted analyses were non-significant.
Conclusions:
- SAIs, predominantly SAP, affect nearly one-third of patients post-MT.
- Several clinical factors are associated with SAI, offering targets for risk stratification.
- While crude mortality is higher with SAI, further research is needed to confirm adjusted mortality impact and explore preventive strategies.
