Abstract Details

Title Embolic Stroke Related to Infective Endocarditic and Its Outcome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 064

Objective

Background BACKGROUND: Endocarditis is a relatively uncommon cause of stroke; there is no consensus guideline over the management of these patients.

Design/Methods DESIGN/METHODS: Using ICD-9 code, patients were selected from The Nationwide Inpatient Sample database, which reflects 20 % of US hospitals over 40 states and was collected from 2001 to 2010.

Results RESULTS: There were 76,554 identified cases of infective endocarditis. Stroke was diagnosed concomitantly in 7,191 (9.39%). Mean age was 61years (SD 16.78) of which 55% were male, majority (54%) being white population. 101 (0.01%) stroke cases received either thrombolysis (81) or mechanical thrombectomy (20). The majority of these interventions were carried out in urban teaching hospitals (72). Mortality occurred in 15 %( 12) of patients who received thrombolysis versus 35% (7) who underwent mechanical thrombectomy. Intracerebral hemorrhage (OR 1.583, 1.249- 2.006), gastrointestinal hemorrhage (OR 1.49, 1.129-1.967), pulmonary complications (OR 5.5, 4.88-6.20) and sepsis (OR 2.88, 2.55-3.25) were significant predictor of in-hospital mortality but thrombolysis (OR 0.84, 0.5-1.42) and mechanical thrombectomy (OR 1.7, 0.67-4.26) were not, probably because of few number of patients in this group. Intracerebral hemorrhage was more likely in patient who underwent mechanical thrombectomy 14.8% (12) and thrombolysis 20% (4) with P value <0.0001. Sepsis, cardiac and pulmonary complications did not differ significantly among patient that received mechanical thrombectomy, thrombolysis or without intervention.

Conclusions CONCLUSIONS: From our retrospective study, intracerebral hemorrhage was more likely in patients with infective endocarditis and stroke who underwent mechanical thrombectomy or thrombolysis. Mortality in the thrombolysis group was lower than mechanical thrombectomy but could not reach statistical significance. We need prospective trial or treatment registry to help guide treatment decision.

Authors/Disclosures
Laxmi P. Dhakal, MD PRESENTER	No disclosure on file
Pankaj Jalan, MD, MBBS, FAAN (Norvic International Hospital)	No disclosure on file
Vijay M. Pandav, MBBS (Advent Health Daytona Beach)	No disclosure on file
Sushant P. Kale, MD	No disclosure on file
Gavin Giovannoni, MD (QMUL)	Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck KGaA. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche-Genentech. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Moderna. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Astoria Biologica. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zenas. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medscape.

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