Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Department of Neurosciences and Mental Health, Serviço de Neurologia, Hospital Santa Maria/Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104598. doi: 10.1016/j.jstrokecerebrovasdis.2019.104598. Epub 2020 Feb 3.
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.
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.
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.
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.
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.
缺血性脑卒中是感染性心内膜炎的常见神经系统并发症。本系统评价旨在评估与溶栓相比，机械取栓术在治疗感染性心内膜炎相关急性缺血性脑卒中患者中的疗效和安全性，并与联合治疗进行比较。
根据系统评价和荟萃分析的首选报告项目进行系统文献综述。本综述纳入了报告在成人感染性心内膜炎相关急性缺血性脑卒中患者中应用机械取栓术、静脉或动脉内溶栓治疗的病例报告、病例系列、横断面研究、病例对照研究、随机对照试验或非随机对照试验。
Scloelo、b-on、Pubmed 和 Cochrane 数据库，检索时间截至 2019 年 4 月。同时也查阅了参考文献列表。我们比较了溶栓、取栓和联合治疗对急性缺血性脑卒中治疗的疗效（独立性、神经功能改善）和安全性（颅内出血、死亡）。
通过系统评价，符合标准的 37 篇文章共描述了 52 例患者。静脉溶栓治疗患者颅内出血风险（P = .001）和联合治疗患者颅内出血风险（P = .01）分别是取栓治疗患者的 4.14 倍和 4.67 倍。与静脉溶栓组相比，取栓组在独立性（P = .09）和神经功能改善（P = .07）方面有获益趋势。
由于现有证据质量较低，取栓术在感染性心内膜炎相关脑卒中患者中似乎比溶栓术或联合治疗更安全。这些结果可能有助于指导临床决策，在选择的患者中。
