Abstract Details

Title Utility Of Retrieved Thromboembolism Tissue Culture In A Patient With Suspected Infective Endocarditis

Topic Cerebrovascular Disease and Interventional Neurology

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

Poster/Presentation
Number 3-061

Objective NA

Background Infective endocarditis (IE) is an infection of the endocardial surface usually involving heart valves or an intracardiac device. Stroke or transient ischemic attack accounts for about 40-50% of neurological complications of IE. Demonstrating microorganisms by blood culture or histology of vegetation/intracardiac abscess is one of the pathological criteria of the Modified Duke criteria; to establish the diagnosis of IE. Here we present a case of an IE presenting as stroke where the microorganism was initially isolated from culture of cerebral clot retrieved during an endovascular thrombectomy before isolation from blood cultures.

Design/Methods 40 year old right-handed man with mechanical aortic valve initially presented to a community Hospital with acute left hemiplegia, left homonymous hemianopsia, left hemi-spatial neglect and moderate-to-severe dysarthria. He was noted to be febrile on presentation. He was not deemed to be a candidate for systemic thrombolysis due to concern for IE and being on anticoagulation with warfarin (INR>1.7). He was transferred to our comprehensive stroke center and was diagnosed with right supraclinoid internal carotid artery (ICA) occlusion on CT angiogram of head and neck. He subsequently underwent mechanical embolectomy with the Solumbra technique and resultant successful revascularization. Transesophageal echocardiogram showed aortic valve endocarditis with aortic root abscess. Thrombus and tissue sample obtained through aspiration of ICA clot were sent for microbiology, which subsequently grew Streptococcus dysgalactiae. He was treated with appropriate antibiotics and subsequently underwent replacement of mechanical aortic valve and aortic root repair. Blood cultures were subsequently positive for same microorganism.

Results NA

Conclusions We present a case of IE in which the infective microorganism was first isolated from the tissue/thrombus retrieved during endovascular thrombectomy, even before blood culture results were available, probably due to a higher concentration of microorganisms in the septic embolus as compared to peripheral blood; and helped in selection of early appropriate antibiotics.

Authors/Disclosures
Anand V. Patel, MD (University of Texas Medical Branch) PRESENTER	Dr. Patel has nothing to disclose.
Jeffrey M. Katz, MD (North Shore University Hospital)	Dr. Katz has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Katz Medical Consulting. The institution of Dr. Katz has received research support from Medtronic.
Richard Libman, MD, FAAN (Northwell Health)	Dr. Libman has nothing to disclose.

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