Abstract Details

Title Outcome of Thrombectomy in Stroke Due to Infective Endocarditis: A Case Series

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-060

Objective To determine the safety and short-term outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy due to septic emboli from infective endocarditis (IE).

Background Although tPA has been shown to improve outcome in ischemic stroke across various etiologies, using tPA in stroke secondary to septic emboli from infective endocarditis carries a significantly higher risk of bleeding due to local arteritis and/or mycotic aneurysms.

Design/Methods In this retrospective case series, we collected data from Boston Medical Center to look at outcomes after thrombectomy in patients who had an ischemic stroke from infective endocarditis. Variables included NIHSS and mRS on presentation and on discharge/follow up.

Results From September 2017 to October 2018, 3 patients underwent mechanical thrombectomy and were confirmed to have IE. The first patient presented with an NIHSS 10. No hemorrhagic conversion occurred after thrombectomy. Discharge NIHSS was 1, and mRS on 1 month follow up was 2. He had known IE prior to thrombectomy. The second patient received tPA for an NIHSS of 22 and was transferred for thrombectomy. Hemorrhagic conversion was seen on the initial CT head. His NIHSS on discharge was 22 (same as on presentation), and mRS on 3 months follow up was 5. He received tPA for an NIHSS of 24, and was transferred for thrombectomy. Hemorrhagic conversion was seen on post-procedure CT head. His most recent NIHSS is 8 and mRS 4 (at 10 days after the stroke). The second and third patients did not have known active IE prior to intervention.

Conclusions Thrombectomy may be a safer and promising option in patients with ischemic stroke secondary to infective endocarditis. A multi-center retrospective study is ongoing.

Authors/Disclosures
Elie Sader, MD PRESENTER	No disclosure on file
Natalie Thom (Boston University School of Medicine)	Ms. Thom has nothing to disclose.
Sandra McDonald, NP (Dartmouth-Hitchcock Medical Center)	No disclosure on file
Mohamad Abdalkader (Boston Medical Center Deptartment Of Radiology)	Mohamad Abdalkader has nothing to disclose.
Thanh Nguyen, MD	Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vesalio. Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avania. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Nguyen has received research support from Boston Medical Center. The institution of Dr. Nguyen has received research support from Society of Vascular and Interventional Neurology.
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Anna Marisa Cervantes-Arslanian, MD, FAAN (BU Dept of Neurology)	Dr. Cervantes-Arslanian has nothing to disclose.

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