Francisco Hernández-Fernández1, Laura Rojas-Bartolomé2, Jorge García-García2, Óscar Ayo-Martín2, Juan David Molina-Nuevo3, Rosa Angélica Barbella-Aponte4, Gemma Serrano-Heras5, Enrique Juliá-Molla3, María José Pedrosa-Jiménez3, Tomás Segura2. 1. Neurology Department, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain. fco.hdez.fdez@gmail.com. 2. Neurology Department, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain. 3. Radiology Department, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain. 4. Neuropatology-Surgical Pathology Departement, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain. 5. Research Unit, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain.
Abstract
PURPOSE: Management of stroke secondary to septic emboli (SE) remains challenging, due to both the lack of specific recommendations and the gravity of the underlying pathology.The aim of this study is to describe the presence of SE in a series of mechanical thrombectomies (MT), analyzing technical complexity and outcomes with respect to the patients by means of histological analysis and microbiological study of the clot. METHODS: All the retrieved clots were studied under an established protocol, including histopathological and bacteriological study with hematoxylin-eosin, Gram and Gomori trichrome staining.Technical complexity in SE with respect to the series was evaluated by analyzing time of the procedures, number of passes and use of intracranial definitive stents. RESULTS: Over a 24-month period, bacteria were detected in the retrieved clot of four out of 65 patients (incidence 6.2%). Two cases were eventually diagnosed with infective endocarditis, while the remaining two were diagnosed with urinary tract infection and respiratory septicemia, respectively. Three of the four patients (75%) required an intracranial definitive stent in order to achieve successful recanalization.These procedures were significantly longer (137.7 vs. 59.8 min, p < 0.001), needed a higher number of passes (5.8 vs. 2.2, p < 0.001), and delivery of an intracranial stent more frequently (75% vs. 1.6%, p = 0.008), with respect to the rest of the series. CONCLUSIONS: In our series, systematic histopathological and bacteriological study of the MT samples allowed a higher proportion of SE diagnosis in comparison with previous reports.
PURPOSE: Management of stroke secondary to septic emboli (SE) remains challenging, due to both the lack of specific recommendations and the gravity of the underlying pathology.The aim of this study is to describe the presence of SE in a series of mechanical thrombectomies (MT), analyzing technical complexity and outcomes with respect to the patients by means of histological analysis and microbiological study of the clot. METHODS: All the retrieved clots were studied under an established protocol, including histopathological and bacteriological study with hematoxylin-eosin, Gram and Gomori trichrome staining.Technical complexity in SE with respect to the series was evaluated by analyzing time of the procedures, number of passes and use of intracranial definitive stents. RESULTS: Over a 24-month period, bacteria were detected in the retrieved clot of four out of 65 patients (incidence 6.2%). Two cases were eventually diagnosed with infective endocarditis, while the remaining two were diagnosed with urinary tract infection and respiratory septicemia, respectively. Three of the four patients (75%) required an intracranial definitive stent in order to achieve successful recanalization.These procedures were significantly longer (137.7 vs. 59.8 min, p < 0.001), needed a higher number of passes (5.8 vs. 2.2, p < 0.001), and delivery of an intracranial stent more frequently (75% vs. 1.6%, p = 0.008), with respect to the rest of the series. CONCLUSIONS: In our series, systematic histopathological and bacteriological study of the MT samples allowed a higher proportion of SE diagnosis in comparison with previous reports.
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Authors: Senna Staessens; Olivier François; Waleed Brinjikji; Karen M Doyle; Peter Vanacker; Tommy Andersson; Simon F De Meyer Journal: Stroke Date: 2021-09-14 Impact factor: 7.914
Authors: Vaclav Prochazka; Tomas Jonszta; Daniel Czerny; Jan Krajca; Martin Roubec; Jirka Macak; Petr Kovar; Petra Kovarova; Martin Pulcer; Renata Zoubkova; Ivo Lochman; Veronika Svachova; Lubomir Pavliska; Adela Vrtkova; David Kasprak; Jaromir Gumulec; John W Weisel Journal: Med Sci Monit Date: 2018-06-11