Gaultier Marnat1, Igor Sibon2, Benjamin Gory3, Sébastien Richard4, Stéphane Olindo2, Arturo Consoli5, Romain Bourcier6, Maeva Kyheng7, Julien Labreuche7, Cyril Darganzali8, Adrien Ter Schiporst9, Florent Gariel1, Raphaël Blanc10, Bertrand Lapergue11. 1. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France. 2. Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France. 3. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France. 4. Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France. 5. Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. 6. Department of Neuroradiology, University Hospital of Nantes, Nantes, France. 7. Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France. 8. Department of Diagnostic and Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France. 9. Department of Neurology, CHRU Gui de Chauliac, Montpellier, France. 10. Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France. 11. Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France.
Abstract
BACKGROUND AND PURPOSE: Successful reperfusion can be achieved in more than two-thirds of patients with usual large-vessel occlusion stroke causes treated with mechanical thrombectomy. However, the safety and outcomes after mechanical thrombectomy in the setting of large-vessel occlusion related to infective endocarditis is not known. In this study, we investigated the impact of mechanical thrombectomy in infective endocarditis patients on angiographic and clinical outcomes. METHODS: This was a multicenter study from five comprehensive stroke centers. We compared the outcomes of mechanical thrombectomy treated stroke patients due to infective endocarditis with patients presenting atrial fibrillation. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage, and mortality. RESULTS: Between June 2013 and March 2019, 28 patients presenting large-vessel occlusion stroke due to IE were included. These cases were matched with 84 large-vessel occlusion stroke related to atrial fibrillation. Successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) was obtained in 85.7%. Symptomatic intracranial hemorrhage, favorable outcome and mortality rates were respectively 8.0%, 25.9%, and 25.9%. In the case-control analysis, we demonstrated no difference in terms of successful reperfusion, procedural complication, symptomatic intracranial hemorrhage, and mortality rates. Three-month favorable outcome was less often achieved in the infective endocarditis group. CONCLUSIONS: Mechanical thrombectomy of infective endocarditis patients presents similar safety and angiographic results compared to patients suffering from atrial fibrillation.
BACKGROUND AND PURPOSE: Successful reperfusion can be achieved in more than two-thirds of patients with usual large-vessel occlusion stroke causes treated with mechanical thrombectomy. However, the safety and outcomes after mechanical thrombectomy in the setting of large-vessel occlusion related to infective endocarditis is not known. In this study, we investigated the impact of mechanical thrombectomy in infective endocarditispatients on angiographic and clinical outcomes. METHODS: This was a multicenter study from five comprehensive stroke centers. We compared the outcomes of mechanical thrombectomy treated strokepatients due to infective endocarditis with patients presenting atrial fibrillation. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage, and mortality. RESULTS: Between June 2013 and March 2019, 28 patients presenting large-vessel occlusion stroke due to IE were included. These cases were matched with 84 large-vessel occlusion stroke related to atrial fibrillation. Successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) was obtained in 85.7%. Symptomatic intracranial hemorrhage, favorable outcome and mortality rates were respectively 8.0%, 25.9%, and 25.9%. In the case-control analysis, we demonstrated no difference in terms of successful reperfusion, procedural complication, symptomatic intracranial hemorrhage, and mortality rates. Three-month favorable outcome was less often achieved in the infective endocarditis group. CONCLUSIONS: Mechanical thrombectomy of infective endocarditispatients presents similar safety and angiographic results compared to patients suffering from atrial fibrillation.