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Intra-Arterial Mechanical Thrombectomy: An Effective Treatment for Ischemic Stroke Caused by Endocarditis

View Article: PubMed Central - PubMed

ABSTRACT

Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy. We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device. From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis. Mechanical thrombectomy is most likely a more effective and safer treatment than intravenous thrombolysis in this patient group.

No MeSH data available.


Related in: MedlinePlus

a CT angiography of the brain showed occlusion of the M1 segment of the middle cerebral artery on the right side (arrow). b CT of the brain exhibited decreased attenuation of the right basal ganglia in keeping with infarction (arrows). c CT perfusion of the brain showing increased mean transit time in the middle cerebral artery territory on the right side (blue area).
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Figure 2: a CT angiography of the brain showed occlusion of the M1 segment of the middle cerebral artery on the right side (arrow). b CT of the brain exhibited decreased attenuation of the right basal ganglia in keeping with infarction (arrows). c CT perfusion of the brain showing increased mean transit time in the middle cerebral artery territory on the right side (blue area).

Mentions: A 67-year-old man with atrial flutter, hypertension, ischemic heart disease, and prosthetic mitral valve treated with warfarin and aspirin had gone to sleep at around 11 p.m. During the previous days he had had mild fever. He woke up at 4 a.m. with left-sided paresis. Forty minutes later, at the emergency department in another hospital, he had dysarthria, left homonymous hemianopsia, left central facial paralysis, reduced sensation in the left side of the body, and a paretic left arm, but could move the left leg a little (NIHSS 13). Initial CT of the brain showed no signs of infarction or hemorrhage. CT angiography showed an M1 occlusion on the right side (Fig 2a). He was transferred to our hospital, where a repeat head CT showed a small infarction of the right basal ganglia (Fig 2b), but at the same time CT perfusion revealed a large penumbra zone, according to infarct-perfusion deficit mismatch, in the right MCA territory (Fig 2c). Mechanical thrombectomy was performed with a good functional outcome (NIHSS 3 at discharge).


Intra-Arterial Mechanical Thrombectomy: An Effective Treatment for Ischemic Stroke Caused by Endocarditis
a CT angiography of the brain showed occlusion of the M1 segment of the middle cerebral artery on the right side (arrow). b CT of the brain exhibited decreased attenuation of the right basal ganglia in keeping with infarction (arrows). c CT perfusion of the brain showing increased mean transit time in the middle cerebral artery territory on the right side (blue area).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121560&req=5

Figure 2: a CT angiography of the brain showed occlusion of the M1 segment of the middle cerebral artery on the right side (arrow). b CT of the brain exhibited decreased attenuation of the right basal ganglia in keeping with infarction (arrows). c CT perfusion of the brain showing increased mean transit time in the middle cerebral artery territory on the right side (blue area).
Mentions: A 67-year-old man with atrial flutter, hypertension, ischemic heart disease, and prosthetic mitral valve treated with warfarin and aspirin had gone to sleep at around 11 p.m. During the previous days he had had mild fever. He woke up at 4 a.m. with left-sided paresis. Forty minutes later, at the emergency department in another hospital, he had dysarthria, left homonymous hemianopsia, left central facial paralysis, reduced sensation in the left side of the body, and a paretic left arm, but could move the left leg a little (NIHSS 13). Initial CT of the brain showed no signs of infarction or hemorrhage. CT angiography showed an M1 occlusion on the right side (Fig 2a). He was transferred to our hospital, where a repeat head CT showed a small infarction of the right basal ganglia (Fig 2b), but at the same time CT perfusion revealed a large penumbra zone, according to infarct-perfusion deficit mismatch, in the right MCA territory (Fig 2c). Mechanical thrombectomy was performed with a good functional outcome (NIHSS 3 at discharge).

View Article: PubMed Central - PubMed

ABSTRACT

Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy. We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device. From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis. Mechanical thrombectomy is most likely a more effective and safer treatment than intravenous thrombolysis in this patient group.

No MeSH data available.


Related in: MedlinePlus