Safety and efficacy of mechanical thrombectomy in infective endocarditis: a matched case-control analysis from the German Stroke Registry-Endovascular Treatment (GSR-ET).

Feil, Katharina; Küpper, Clemens; Tiedt, Steffen; Dimitriadis, Konstantinos; Herzberg, Moriz; Dorn, Franziska; Liebig, Thomas; Dieterich, Marianne; Kellert, Lars

BACKGROUND Up to 30% of infective endocarditis (IE) patients have ischemic stroke as complication. Standard treatment with mechanical thrombectomy (MT) with or without intravenous thrombolysis (IVT) for large vessel occlusion (LVO) has not been evaluated formally in these patients. METHODS Patients enrolled in the German Stroke Registry-endovascular treatment (GSR-ET) between 06/2015 and 12/2019 were analyzed. Patients with stroke due to IE and patients with cardio-embolic stroke and atrial fibrillation (AF) were compared using propensity score matching. Successful reperfusion was defined as modified Thrombolysis In Cerebral Infarction (mTICI) score 2b-3. Modified Rankin Scale (mRS) 0-2 at 3 months indicated good outcome. RESULTS Of 6635 patients, 55 patients (age 69.0±13.3 years, 43.6% female, median pmRS 1 (IQR 0,1), NIHSS 15 (10, 21)) presented with septic embolic stroke due to IE and were compared to 104 patients (age 66.5±13.4 years, 39.4% female, pmRS 0 (0, 2), NIHSS 16 (10, 20)) with cardioembolic stroke due to AF. Successful recanalization was achieved in 74.5% of endocarditis patients compared to 87.5% of controls (p=0.039). Intracranial hemorrhage rates were comparable (30.9% versus 21.6%, p=0.175). Good functional outcome was 20.0% in patients with IE compared to 43.3% in matched patients (p=0.006) with a significantly higher mortality (60.0% versus 28.8%, p<0.001). IE was strongly associated with poor outcome (OR 0.32, 95% CI 0.11-0.87, p=0.03 for good outcome) and mortality (OR 4.49, 95% CI 1.80-10.68, p=0.001). CONCLUSIONS Although MT results in high successful recanalization rates with acceptable safety profile, patients with LVO stroke due to IE have a poor outcome.