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Letter to the editor| Volume 29, ISSUE 6, 104784, June 2020

Safety and Efficacy of Thrombolysis and Mechanical Thrombectomy in Infective Endocarditis

  • Author Footnotes
    1 Postgraduate in Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
    Ajay Kumar Mishra
    Correspondence
    Address correspondence to Ajay Kumar Mishra, MD, Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester MA 01608.
    Footnotes
    1 Postgraduate in Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
    Affiliations
    Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
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  • Author Footnotes
    1 Postgraduate in Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
    Kamal Kant Sahu
    Footnotes
    1 Postgraduate in Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
    Affiliations
    Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
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  • Author Footnotes
    2 Assistant Professor Dermatology, Christian Medical College.
    Anu Anna George
    Footnotes
    2 Assistant Professor Dermatology, Christian Medical College.
    Affiliations
    Department of Dermatology, CMC, Vellore, Tamil Nadu, India
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  • Author Footnotes
    3 Critical care fellow in Mayo Clinic, Rochester, Minnesota.
    Amos Lal
    Footnotes
    3 Critical care fellow in Mayo Clinic, Rochester, Minnesota.
    Affiliations
    Department of Critical Care, Mayo Clinic, Rochester, Minnesota
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  • Author Footnotes
    1 Postgraduate in Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
    2 Assistant Professor Dermatology, Christian Medical College.
    3 Critical care fellow in Mayo Clinic, Rochester, Minnesota.
      We 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.
      • Bettencourt S.
      • Ferro J.M.
      Acute ischemic stroke treatment in infective endocarditis: systematic review.
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      References

        • Bettencourt S.
        • Ferro J.M.
        Acute ischemic stroke treatment in infective endocarditis: systematic review.
        J Stroke Cerebrovasc Dis. 2020; ([Epub ahead of print] PubMed PMID:32024600)104598https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104598
      1. K.K. Sahu, A.K. Mishra, A. Lal, et al. An interesting case of expressive aphasia: Enterococcus faecalis-related infective endocarditis complicating as septic emboli, QJM, doi:doi.org/10.1093/qjmed/hcz169.

        • Cao G.F.
        • Liu W.
        • Bi Q.
        Stroke in patients with infective endocarditis: a 15-year single-center cohort study.
        Eur Neurol. 2018; 80 (Epub 2018 Nov 28. PubMed PMID:30485851): 171-178https://doi.org/10.1159/000495149
        • Valenzuela I.
        • Hunter M.D.
        • Sundheim K.
        • et al.
        Clinical risk factors for acute ischaemic and haemorrhagic stroke in patients with infective endocarditis.
        Intern Med J. 2018; 48 (PubMed PMID:29740951PubMed Central PMCID: PMC6125215): 1072-1080https://doi.org/10.1111/imj.13958
      2. A.K. Mishra, K.K. Sahu, A. Lal, et al. Systemic embolization following fungal infective endocarditis, QJM, Doi: doi.org/10.1093/qjmed/hcz274.

        • Anderson D.J.
        • Goldstein L.B.
        • Wilkinson W.E.
        • et al.
        Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis.
        Neurology. 2003; 61 (PubMed PMID:14638952): 1341-1346
      3. A.K. Mishra, K.K. Sahu, A. Lal, et al. Aortic valve abscess: Staphylococcus epidermidis and infective endocarditis, QJM, doi:doi.org/10.1093/qjmed/hcz151.

        • Mishra A.K.
        • Lal A.
        • George A.A.
        Letter by Mishra et al regarding article, "Infection as a stroke trigger: associations between different organ system infection admissions and stroke subtypes".
        Stroke. 2019; 50 (Epub 2019 Sep 26. PubMed PMID:31554499): e328https://doi.org/10.1161/STROKEAHA.119.026990
        • Marquardt R.J.
        • Cho S.M.
        • Thatikunta P.
        • et al.
        Acute ischemic stroke therapy in infective endocarditis: case series and systematic review.
        J Stroke Cerebrovasc Dis. 2019; 28 (Epub 2019 May 23. PubMed PMID:31129109): 2207-2212https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.04.039
        • Valenzuela C.
        2 solutions for estimating odds ratios with zeros.
        Rev Med Chil. 1993; 121 (Spanish. PubMed PMID:8085071): 1441-1444
        • Mishra A.K.
        • Iyadurai R.
        Prehospital and hospital delays for stroke patients treated with thrombolysis: access to health care facility—still a bottle neck in stroke care in developing nation.
        Australas Emerg Care. 2019; 22 (Epub 2019 Aug 17. PubMed PMID:31431390): 227-228https://doi.org/10.1016/j.auec.2019.07.003

      Linked Article

      • Acute Ischemic Stroke Treatment in Infective Endocarditis: Systematic Review
        Journal of Stroke and Cerebrovascular DiseasesVol. 29Issue 4
        • Preview
          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.
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      • Response to the Letter by Ajay K Mishra and Co-workers Commenting on “Safety and Efficacy of Thrombolysis and Mechanical Thrombectomy in Infective Endocarditis”
        Journal of Stroke and Cerebrovascular DiseasesVol. 29Issue 6
        • Preview
          We thank you for your interest in our recent systematic review and share your view that the efficacy results of thrombolysis and mechanical thrombectomy in infective endocarditis should be read with caution, because of the low quality of available evidence, as shown in our review.
        • Full-Text
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