• Carmen Ramos, Pablo Mayo, Santiago Trillo, Carlos Gómez-Escalonilla, Jose Luis Caniego, Manuel Moreu, Juan Vega, Santiago Rosati, Patricia Simal, Álvaro Ximénez Carrillo, Jose Antonio Egido, and José Vivancos.
• Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain. Electronic address: cramosmartin90@gmail.com.
• J Stroke Cerebrovasc Dis. 2020 Nov 1; 29 (11): 105248.

IntroductionAcute ischemic stroke is the most common neurological complication of infective endocarditis. Intravenous thrombolysis is contraindicated in these patients due to a higher risk of hemorrhagic complications. Whether mechanical thrombectomy has some benefit in these patients remains unanswered although some favorable results can be found in literature.MethodsWe report twelve cases of acute ischemic stroke due to septic emboli treated with mechanical thrombectomy in two comprehensive stroke centers.ResultsMedian age was 63 years (IQR 58.8-77.5 years). Diagnosis of infective endocarditis was previous to the diagnosis of stroke in three of the patients. There were five cases of prosthetic-valve endocarditis and eight cases of native-valve endocarditis. Two patients were treated with intravenous thrombolysis with an extensive subarachnoid hemorrhage in 24 h follow-up CT in one of them. Another patient suffered an arterial perforation during the endovascular procedure without successful recanalization. 6 of the patients (50%) developed some type of hemorrhagic complications with three cases of symptomatic intracerebral hemorrhage. Early neurological recovery was achieved in 3 (25%) patients. Functional independence at 3 months in patients with successful revascularization was reached in 50% of the cases.ConclusionsIn patients with large vessel acute ischemic stroke related to infective endocarditis, mechanical thrombectomy might be considered with some potential benefit reported. There may be a high risk of hemorrhagic complications, as known for intravenous thrombolysis in this condition, suggesting that this procedure should be carefully evaluated in these patients.Copyright © 2020 Elsevier Inc. All rights reserved.

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