Gonçalves Ocílio Ribeiro, de Almeida Monteiro Gabriel, Santos Ana B, Arruda Gabriel, Mutarelli Antonio, Marinheiro Gabriel, Martins Kleuber Arias Meireles, Leite Marianna, Dominici Saul, Cronemberger Társis Vinícius, Günkan Ahmet, Almeida Kelson James, Ferreira Marcio Yuri, Ferreira Christian, Gordon David, Serulle Yafell
Department of Medicine, Federal University of Piauí, Teresina, PI, Brazil.
School of Medicine, Federal University of Ceará, Sobral, CE, Brazil.
Clin Neuroradiol. 2025 Aug 19. doi: 10.1007/s00062-025-01547-y.
Acute ischemic stroke (AIS) is the most common neurological complication of infective endocarditis (IE), occurring in 20-40% of patients. In this context, while mechanical thrombectomy (MT) is the standard treatment for patients with AIS due to large-vessel occlusion (LVO), its efficacy and safety in patients with stroke secondary to IE remain unclear.
Therefore, a more robust analysis of the efficacy and safety of MT in patients with AIS due to IE was conducted to address the gaps identified in previous studies.
An extensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases was conducted from inception to December 2024. The endpoints of interest were: (1) favorable functional outcomes at 90 days, (2) successful recanalization, (3) symptomatic intracranial hemorrhage (sICH), (4) any intracranial hemorrhage (aICH), and (5) overall mortality. The pooled proportion rates were employed with a random effects model with 95% Confidence Intervals (CI) and risk ratios (RR) for binary outcomes with 95% CI. I statistics and Cochran Q test were performed to verify the heterogeneity.
Eight studies published between 2017 and 2024 enrolled 2037 patients (mean age 57.9 years, 62.3% women), of whom 1401 (69%) received mechanical or endovascular thrombectomy for Infective Endocarditis-Related Large Vessel Occlusion (IE-LVO) stroke. A pooled proportion of 29.0% for favorable functional outcomes (mRS 0-2) was reported (95% CI 14.0-43.0%; I = 65.7%). Successful recanalization (mTICI 2b-3) was observed in 76.0% of patients (95% CI 68.0-84.0%; I = 23.6%). sICH was reported in 19.0% (95% CI 0.0-38.0%; I = 49.2%) and aICH in 30.0% of the patients (95% CI 23.0-38.0%; I = 78.3%). A pooled proportion of 33.0% for all-cause mortality was evidenced (95% CI 21.0-45.0%; I = 90.4%). A significantly lower incidence of favorable functional outcomes (mRS 0-2) was observed in patients with IE-LVO who underwent MT compared to non-IE-LVO patients (RR 0.48; 95% CI 0.31-0.75; I = 0.0%), and no significant difference in the incidence of aICH was found between patients with IE-LVO and those with non-IE-LVO who underwent MT (RR 1.38; 95% CI 0.96-1.98; I = 62.4%).
High successful recanalization rates were achieved in this population through MT, demonstrating its potential as an effective treatment for IE-LVO. However, the clinical outcomes of patients with IE-LVO were significantly unfavorable compared with those of patients without IE-LVO.
急性缺血性卒中（AIS）是感染性心内膜炎（IE）最常见的神经并发症，发生率为20%-40%。在此背景下，虽然机械取栓术（MT）是因大血管闭塞（LVO）导致的AIS患者的标准治疗方法，但其在IE继发卒中患者中的疗效和安全性仍不明确。
因此，对MT治疗IE所致AIS患者的疗效和安全性进行了更全面的分析，以弥补既往研究中发现的不足。
从数据库建立至2024年12月，对PubMed、Embase、Cochrane对照试验中心注册库、Web of Science和Scopus数据库进行了广泛检索。感兴趣的终点指标包括：（1）90天时良好的功能结局；（2）成功再通；（3）症状性颅内出血（sICH）；（4）任何颅内出血（aICH）；（5）总体死亡率。采用随机效应模型计算合并比例率及95%置信区间（CI），对于二分类结局采用95%CI的风险比（RR）。进行I统计量和Cochran Q检验以验证异质性。
2017年至2024年发表的8项研究纳入了2037例患者（平均年龄57.9岁，62.3%为女性），其中1401例（69%）因感染性心内膜炎相关大血管闭塞（IE-LVO）性卒中接受了机械或血管内取栓治疗。报告的良好功能结局（改良Rankin量表评分0-2分）的合并比例为29.0%（95%CI 14.0%-43.0%；I=65.7%）。76.0%的患者实现了成功再通（脑梗死溶栓分级2b-3级）（95%CI 68.0%-84.0%；I=23.6%）。19.0%的患者发生了sICH（95%CI 0.0%-38.0%；I=49.2%），30.0%的患者发生了aICH（95%CI 23.0%-38.0%；I=78.3%）。全因死亡率的合并比例为33.0%（95%CI 21.0%-45.0%；I=90.4%）。与非IE-LVO患者相比，接受MT治疗的IE-LVO患者良好功能结局（改良Rankin量表评分0-2分）的发生率显著较低（RR 0.48；95%CI 0.31-0.75；I=0.0%），接受MT治疗的IE-LVO患者与非IE-LVO患者之间aICH的发生率未发现显著差异（RR 1.38；95%CI 0.96-1.98；I=62.4%）。
该人群通过MT实现了较高的成功再通率，证明了其作为IE-LVO有效治疗方法的潜力。然而，与非IE-LVO患者相比，IE-LVO患者的临床结局明显不佳。
