Clin Neuroradiol. 2025 Aug 19. doi: 10.1007/s00062-025-01547-y. Online ahead of print.
ABSTRACT
INTRODUCTION: Acute ischemic stroke (AIS) is the most common neurological complication of infective endocarditis (IE), occurring in 20-40% of patients. In this context, while mechanical thrombectomy (MT) is the standard treatment for patients with AIS due to large-vessel occlusion (LVO), its efficacy and safety in patients with stroke secondary to IE remain unclear.
OBJECTIVE: Therefore, a more robust analysis of the efficacy and safety of MT in patients with AIS due to IE was conducted to address the gaps identified in previous studies.
METHODS: An extensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases was conducted from inception to December 2024. The endpoints of interest were: (1) favorable functional outcomes at 90 days, (2) successful recanalization, (3) symptomatic intracranial hemorrhage (sICH), (4) any intracranial hemorrhage (aICH), and (5) overall mortality. The pooled proportion rates were employed with a random effects model with 95% Confidence Intervals (CI) and risk ratios (RR) for binary outcomes with 95% CI. I2 statistics and Cochran Q test were performed to verify the heterogeneity.
RESULTS: Eight studies published between 2017 and 2024 enrolled 2037 patients (mean age 57.9 years, 62.3% women), of whom 1401 (69%) received mechanical or endovascular thrombectomy for Infective Endocarditis-Related Large Vessel Occlusion (IE-LVO) stroke. A pooled proportion of 29.0% for favorable functional outcomes (mRS 0-2) was reported (95% CI 14.0-43.0%; I2 = 65.7%). Successful recanalization (mTICI 2b-3) was observed in 76.0% of patients (95% CI 68.0-84.0%; I2 = 23.6%). sICH was reported in 19.0% (95% CI 0.0-38.0%; I2 = 49.2%) and aICH in 30.0% of the patients (95% CI 23.0-38.0%; I2 = 78.3%). A pooled proportion of 33.0% for all-cause mortality was evidenced (95% CI 21.0-45.0%; I2 = 90.4%). A significantly lower incidence of favorable functional outcomes (mRS 0-2) was observed in patients with IE-LVO who underwent MT compared to non-IE-LVO patients (RR 0.48; 95% CI 0.31-0.75; I2 = 0.0%), and no significant difference in the incidence of aICH was found between patients with IE-LVO and those with non-IE-LVO who underwent MT (RR 1.38; 95% CI 0.96-1.98; I2 = 62.4%).
CONCLUSION: High successful recanalization rates were achieved in this population through MT, demonstrating its potential as an effective treatment for IE-LVO. However, the clinical outcomes of patients with IE-LVO were significantly unfavorable compared with those of patients without IE-LVO.
PMID:40830541 | DOI:10.1007/s00062-025-01547-y
