Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review

Rohan Maheshwari; Dennis J Cordato; Daniel Wardman; Peter Thomas; Sonu M M Bhaskar

doi:10.1177/11795735221081597

Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review

J Cent Nerv Syst Dis. 2022 Mar 7:14:11795735221081597. doi: 10.1177/11795735221081597. eCollection 2022.

Authors

Rohan Maheshwari^{1

2}, Dennis J Cordato^{2

3

4}, Daniel Wardman^{2

3

4}, Peter Thomas^{3

4}, Sonu M M Bhaskar^{1

2

3

5

4}

Affiliations

¹ Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
² South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia.
³ Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia.
⁴ Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
⁵ NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia.

Abstract

Background: Acute ischemic stroke (AIS) is a common and fatal complication of infective endocarditis (IE); however, there is a lack of understanding regarding treatment efficacy. This systematic review aimed to evaluate the safety and efficacy of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) in IE patients experiencing AIS.

Objectives: The aim of this study was to perform a systematic review investigating the outcomes of AIS in IE patients receiving IVT and/or EVT as a treatment method and to evaluate the safety and efficacy of these methods of reperfusion therapy.

Design: A systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted.

Data sources and methods: The EMBASE, Cochrane, and PubMed databases were searched for literature published between 2005 and 2021 investigating outcomes of reperfusion therapy post-AIS in IE and non-IE patients. Descriptive statistics were used to describe the overall frequency of clinical outcomes, and groupwise comparisons were performed using Fisher's exact test to assess the significance of groupwise differences.

Results: Three studies were finally included in the systematic review. A total of 13.5% of IE patients compared to 37% of non-IE patients achieved a good functional outcome (modified Rankin Scale score≤ 2) (P < .001). Furthermore, a larger percentage of the IE cohort achieved good functional outcomes after EVT (22.0%) compared to IVT (10.4%) (P = .013). The IE cohort also had a higher 3-month postreperfusion mortality rate (48.8%) compared to the non-IE cohort (24.9%) (P < .001). The rate of intracranial hemorrhage (ICH) postreperfusion was also significantly higher in the IE cohort (23.5%) than in the non-IE cohort (6.5%) (P < .001).

Conclusion: AIS patients with IE, treated with IVT, EVT, or a combination of the two, experience worse clinical and safety outcomes than non-IE patients. EVT yielded better functional outcomes, albeit with higher postreperfusion ICH rates, than IVT.

Keywords: cardiovascular; cerebrovascular; infective endocarditis; pathology; prognosis; reperfusion; stroke.

Publication types

Review