Efficacy and Safety of Mechanical Thrombectomy in Acute Ischemic Stroke Secondary to Infective Endocarditis.

Objectives: Acute ischemic strokes (stroke) are frequent and severe extracardiac complications in infective endocarditis (IE). Since intravenous thrombolysis (IV-thrombolysis) is contraindicated, mechanical thrombectomy (thrombectomy) offers potential benefit. We aimed to compare thrombectomy efficacy and safety between IE-related and general stroke cases.

Methods: Multicenter study of consecutive IE cases treated with thrombectomy at nine stroke centers in Spain from 2011 to 2022. Using propensity score matching, 50 IE cases were 1:4 matched with non-IE stroke patients (n=200). Efficacy was defined by successful recanalization rates [modified treatment in cerebral ischemia scale (mTICI) ≥2b], neurological improvement at 24 hours [decrease of National Institutes of Health Stroke Scale (NIHSS) compared to baseline], and good neurological outcome rates at 3 months [modified Rankin scale (mRS) ≤ 2]. Safety was assessed by intracranial hemorrhage (IC-hemorrhage), symptomatic IC-hemorrhage, crude mortality, and stroke-related mortality.

Results: Among 54 IE cases, 50 were matched with 200 controls. Successful recanalization was similarly achieved in both groups (76% vs 83%). Median NIHSS at 24h was comparable, with analogous rates of neurological improvement (78% vs 78%), and early dramatic response (48% vs 46.5%). No differences were seen regarding IC-hemorrhage rates, except for when prior IV-thrombolysis was given. Although crude mortality was higher in the IE cohort, no differences were seen in stroke-related mortality (12% vs 15%). At three months, mRS scores of the two groups were superimposable.

Conclusions: Thrombectomy in IE is as effective and safe as in non-IE patients, and prior IV-thrombolysis could decrease the procedural safety. Clinical practice guidelines may consider including the recommendation to perform thrombectomy alone in IE-related stroke.