Abstract
Background: Ischemic stroke is a frequent neurologic complication of infective endocarditis.
This systematic review aims to evaluate the efficacy and safety of thrombectomy in
comparison to thrombolysis and to combined treatment in patients with infective endocarditis
associated acute ischemic stroke. Methods: A systematic literature review was performed following Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guidelines. The review included case reports,
cases series, cross-sectional studies, case control studies, randomized controlled
trials or nonrandomized controlled trials, which reported the treatment of endocarditis-related
acute ischemic stroke with mechanical thrombectomy, intravenous or intra-arterial
thrombolysis in adult patients. Data sources: Scielo, b-on, Pubmed and Cochrane, from
inception to April 2019. Reference lists were also checked. We compared the efficacy
(independence, neurological improvement) and safety (intracranial bleeding, death)
of acute ischemic stroke treatment with thrombolysis, thrombectomy and combined therapy.
Results: Through systematic review 37 articles describing 52 patients met criteria. The risk
of intracranial hemorrhage was 4.14 times higher in patients treated with intravenous
thrombolysis (P = .001) and 4.67 times higher in patients treated with combined treatment (P = .01). There was trend for independence (P = .09) and neurological improvement (P = .07) in favor of thrombectomy, when comparing this group to the group treated with
intravenous thrombolysis. Conclusions: With the limitation of the low quality of the available evidence, thrombectomy in
infective endocarditis associated stroke appears to be safer than thrombolysis, or
combined treatment. These results may be useful to guide clinical decisions, in selected
patients.
Key Words
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Article info
Publication history
Published online: February 03, 2020
Accepted:
December 9,
2019
Received in revised form:
December 7,
2019
Received:
September 30,
2019
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104598
Copyright
© 2019 Elsevier Inc. All rights reserved.
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- Safety and Efficacy of Thrombolysis and Mechanical Thrombectomy in Infective EndocarditisJournal of Stroke and Cerebrovascular DiseasesVol. 29Issue 6
- PreviewWe read with much interest the article “Acute Ischemic Stroke Treatment in Infective Endocarditis: Systemic Review” by Bettencourt et al, published in your esteemed journal. Authors have reviewed 37 articles including 52 patients. Sixteen of whom received IV thrombolysis, 22 received mechanical thrombectomy, 11 received combined treatment. The authors stated that the quality of the articles were low. And have concluded that the risk of intracerebral hemorrhage was 4 times higher in the group treated with IV thrombolysis comparing to the group treated with thrombectomy.
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