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KMID : 1005420200220030176
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Journal of Cerebrovascular and Endovascular Neurosurgery
2020 Volume.22 No. 3 p.176 ~ p.181
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Clinical challenges associated with the endovascular treatment of acute stroke in a patient with infective endocarditis
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Settarzade Emil
Peker Ahmet
Topcuoglu M. Akif
Arsava E. Murat
Demircin Metin
Arat Anil
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Abstract
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Although stroke is common in infective endocarditis (IE), only 26 cases of thrombectomy have been reported to date for IE-related acute stroke. We report a 40-year-old man who presented with left middle cerebral artery occlusion of unknown cause. Multiple attempts of mechanical aspiration thrombectomy and stentrievers failed to recanalize the artery. Effective revascularization was eventually achieved by placing a self-expanding intracranial stent. Post-procedurally the patient was diagnosed with IE with mitral valve insufficiency, mandating emergent valvular replacement while the patient was still on tirofiban infusion. On follow-up, the patient had a modified Rankin’s score of 0, had no recurrent stroke, and the intracranial stent remained patent yet stenosed. Based on the use of a self-expanding intracranial stent in the setting of IE, we discuss the consequences of the fibrotic and inflammatory content of the embolus and the associated high risk of intracranial hemorrhage which complicates clinical decision making.
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KEYWORD
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Stroke, Infective endocarditis, Stent
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