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Acute Ischemic Stroke Therapy in Infective Endocarditis: Case Series and Systematic Review.
- Source :
-
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2019 Aug; Vol. 28 (8), pp. 2207-2212. Date of Electronic Publication: 2019 May 23. - Publication Year :
- 2019
-
Abstract
- Objectives: To evaluate the safety of acute ischemic stroke (AIS) therapy in patients with infective endocarditis (IE) with intravenous thrombolysis (IVT) or endovascular therapy (EVT) such as mechanical thrombectomy.<br />Methods: We conducted a retrospective study of patients who underwent AIS therapy with IVT or EVT at a tertiary referral center from 2013 to 2017, that were later diagnosed with acute IE as the causative mechanism. We then performed a systematic review of reports of acute ischemic reperfusion therapy in IE since 1995 for their success rates in terms of neurological outcome, and mortality, and their risk of hemorrhagic complication.<br />Results: In the retrospective portion, 8 participants met criteria, of whom 4 received IVT and 4 received EVT. Through systematic review, 24 publications of 32 participants met criteria. Combined, a total of 40 participants were analyzed: 18 received IVT alone, 1 received combined IVT plus EVT, and 21 received EVT alone. IVT compared to EVT were similar in rates of good neurologic outcomes (58% versus 76%, P= .22) and mortality (21% versus 19%, P= .87), but had higher post-therapy intracranial hemorrhage (63% versus 18% [P= .006]).<br />Conclusion: IV thrombolysis has a higher rate of post-therapy intracranial hemorrhage compared to EVT. EVT should be considered as first-line AIS therapy for patients with known, or suspected, IE who present with a large vessel occlusion.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Administration, Intravenous
Adult
Aged
Aged, 80 and over
Brain Ischemia diagnosis
Brain Ischemia etiology
Brain Ischemia mortality
Endocarditis diagnosis
Endocarditis mortality
Endovascular Procedures adverse effects
Endovascular Procedures mortality
Female
Fibrinolytic Agents adverse effects
Humans
Intracranial Hemorrhages chemically induced
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Stroke diagnosis
Stroke etiology
Stroke mortality
Thrombectomy adverse effects
Thrombectomy mortality
Thrombolytic Therapy adverse effects
Thrombolytic Therapy mortality
Treatment Outcome
Brain Ischemia therapy
Endocarditis complications
Endovascular Procedures methods
Fibrinolytic Agents administration & dosage
Stroke therapy
Thrombectomy methods
Thrombolytic Therapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8511
- Volume :
- 28
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
- Publication Type :
- Academic Journal
- Accession number :
- 31129109
- Full Text :
- https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.04.039