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Pisaryuk AS, Zamarashkina VA, Safarova NB, Povalyaev NM, Kotova EO, Babukhina UI, Koltsova EM, Kobalava ZD. Coagulation Disorders in Infective Endocarditis: Role of Pathogens, Biomarkers, Antithrombotic Therapy (Systematic Review). RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-06-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The issue of antithrombotic therapy in patients with infective endocarditis has been studied for over 75 years. During that time studying of pathogenesis of the disease and its embolic complications, lead to the introduction of the concept of “immunothrombosis”. That mechanism allows infective agents (mostly bacteria) to be cloaked from the immune system and to multiply freely, leading to growth of vegetation, thus resulting in higher chance of fragmentation. Small-scale experimental and clinical studies on the correction of hemostatic disorders in infective endocarditis, that were performed in 20th century, didn’t show any significant results, that could affect clinical practice. However, reinterpretation of available data on coagulative system will allow to have elements of hemostasis as an application point in treating infective endocarditis. The article will discuss latest insights on the role of hemostasis system in pathophysisology of infective endocarditis, its effects on the development of the embolic complications, perspectives for diagnostics and treatment.
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Affiliation(s)
- A. S. Pisaryuk
- RUDN University; Moscow City Hospital named after V.V. Vinogradov
| | | | | | | | | | | | - E. M. Koltsova
- Center for Theoretical Problems of Physicochemical Pharmacology; Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology
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2
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Berge E, Whiteley W, Audebert H, De Marchis GM, Fonseca AC, Padiglioni C, de la Ossa NP, Strbian D, Tsivgoulis G, Turc G. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J 2021; 6:I-LXII. [PMID: 33817340 DOI: 10.1177/2396987321989865] [Citation(s) in RCA: 506] [Impact Index Per Article: 168.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
Intravenous thrombolysis is the only approved systemic reperfusion treatment for patients with acute ischaemic stroke. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions with regard to intravenous thrombolysis for acute ischaemic stroke. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Expert consensus statements were provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high quality evidence to recommend intravenous thrombolysis with alteplase to improve functional outcome in patients with acute ischemic stroke within 4.5 h after symptom onset. We also found high quality evidence to recommend intravenous thrombolysis with alteplase in patients with acute ischaemic stroke on awakening from sleep, who were last seen well more than 4.5 h earlier, who have MRI DWI-FLAIR mismatch, and for whom mechanical thrombectomy is not planned. These guidelines provide further recommendations regarding patient subgroups, late time windows, imaging selection strategies, relative and absolute contraindications to alteplase, and tenecteplase. Intravenous thrombolysis remains a cornerstone of acute stroke management. Appropriate patient selection and timely treatment are crucial. Further randomized controlled clinical trials are needed to inform clinical decision-making with regard to tenecteplase and the use of intravenous thrombolysis before mechanical thrombectomy in patients with large vessel occlusion.
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Affiliation(s)
- Eivind Berge
- Department of Internal Medicine and Cardiology, Oslo University Hospital, Oslo, Norway
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Heinrich Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin & Center for Stroke Research Berlin, Berlin, Germany
| | - Gian Marco De Marchis
- University Hospital of Basel & University of Basel, Department for Neurology & Stroke Center, Basel, Switzerland
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Chiara Padiglioni
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | | | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hopital Sainte-Anne, Université de Paris, Paris, France.,INSERM U1266.,FHU NeuroVasc
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3
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Chakraborty T, Rabinstein A, Wijdicks E. Neurologic complications of infective endocarditis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:125-134. [PMID: 33632430 DOI: 10.1016/b978-0-12-819814-8.00008-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Infective endocarditis (IE) is an infection primarily affecting the endocardium of heart valves that can embolize systemically and to the brain. Neurologic manifestations include strokes, intracerebral hemorrhages, mycotic aneurysms, meningitis, cerebral abscesses, and infections of the spine. Neurologic involvement is associated with worse mortality, though it does not always portend a poor functional prognosis. Neuroimaging is indicated in patients who have neurologic symptoms, including cerebral vessel imaging in patients who have subarachnoid hemorrhage. In the case of acute ischemic stroke (IS), IV thrombolysis is contraindicated but endovascular thrombectomy may be a consideration. Neurologic findings understandably raise concern about valve surgery when indicated due to the risk of hemorrhage with perioperative anticoagulation. However, most neurologic complications do not preclude valve surgery and valve surgery may in fact be indispensable in some cases to prevent further neurologic problems. Management decisions in patients with IE and neurologic complications should therefore be multidisciplinary with a major contribution from the neurologist.
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Affiliation(s)
- Tia Chakraborty
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Eelco Wijdicks
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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4
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Yuki T, Shimozato R, Iijima A. [The pathology of the thrombi obtained by endovascular thrombectomy were useful for diagnosis of two cases of cardiogenic cerebral embolism due to infective endocarditis and nonbacterial thrombotic endocarditis]. Rinsho Shinkeigaku 2020; 60:846-851. [PMID: 33229830 DOI: 10.5692/clinicalneurol.cn-001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patient 1 was a 55-year-old male with cerebral infarction due to obstruction of the left middle cerebral artery during treatment for bacteremia, along with a verruca of infectious endocarditis harvested from endovascular thrombectomy. Patient 2 was a 59-year-old female suffering from cerebral infarction at the terminal branch during intrahepatic cholangiocarcinoma chemotherapy who thereafter developed cerebral infarction again due to obstruction of the left middle cerebral artery, along with a verruca of nonbacterial thrombotic endocarditis (NBTE) harvested from endovascular thrombectomy. In tumor-bearing patients, while NBTE may be more closely related to the development of cerebral infarctions than previously assumed, we also need pay attention to the onset of infectious endocarditis. We need further studies on the effectiveness and safety of thrombolysis therapy and endovascular thrombectomy for cerebral infarctions due to endocarditis in both patients. The harvested emboli may provide clues to the differentiation thereof.
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Affiliation(s)
- Takakazu Yuki
- Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center
| | - Rin Shimozato
- Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center
| | - Akira Iijima
- Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center
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5
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Marnat G, Sibon I, Gory B, Richard S, Olindo S, Consoli A, Bourcier R, Kyheng M, Labreuche J, Darganzali C, Schiporst AT, Gariel F, Blanc R, Lapergue B. Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: A case–control study. Int J Stroke 2020; 16:585-592. [DOI: 10.1177/1747493020925360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and purpose Successful reperfusion can be achieved in more than two-thirds of patients with usual large-vessel occlusion stroke causes treated with mechanical thrombectomy. However, the safety and outcomes after mechanical thrombectomy in the setting of large-vessel occlusion related to infective endocarditis is not known. In this study, we investigated the impact of mechanical thrombectomy in infective endocarditis patients on angiographic and clinical outcomes. Methods This was a multicenter study from five comprehensive stroke centers. We compared the outcomes of mechanical thrombectomy treated stroke patients due to infective endocarditis with patients presenting atrial fibrillation. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage, and mortality. Results Between June 2013 and March 2019, 28 patients presenting large-vessel occlusion stroke due to IE were included. These cases were matched with 84 large-vessel occlusion stroke related to atrial fibrillation. Successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) was obtained in 85.7%. Symptomatic intracranial hemorrhage, favorable outcome and mortality rates were respectively 8.0%, 25.9%, and 25.9%. In the case–control analysis, we demonstrated no difference in terms of successful reperfusion, procedural complication, symptomatic intracranial hemorrhage, and mortality rates. Three-month favorable outcome was less often achieved in the infective endocarditis group. Conclusions Mechanical thrombectomy of infective endocarditis patients presents similar safety and angiographic results compared to patients suffering from atrial fibrillation.
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Affiliation(s)
- Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Stéphane Olindo
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Maeva Kyheng
- Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - Julien Labreuche
- Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - Cyril Darganzali
- Department of Diagnostic and Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | | | - Florent Gariel
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
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6
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Acute Ischemic Stroke Treatment in Infective Endocarditis: Systematic Review. J Stroke Cerebrovasc Dis 2020; 29:104598. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104598] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 01/16/2023] Open
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7
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Kadam M, Birns J, Bhalla A. The management of infective endocarditis complicated by stroke. Int J Clin Pract 2020; 74:e13469. [PMID: 31877574 DOI: 10.1111/ijcp.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/21/2019] [Accepted: 12/22/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Mustafa Kadam
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Jonathan Birns
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Ajay Bhalla
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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8
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Mantero V, Rigamonti A, Basilico P, Sangalli D, Scaccabarozzi C, Salmaggi A. Stroke in a Feverish Patient with COVID-19 Infection and Unknown Endocarditis. J Clin Neurol 2020; 16:707-708. [PMID: 33029982 PMCID: PMC7541976 DOI: 10.3988/jcn.2020.16.4.707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Paola Basilico
- Neurology Unit, “A. Manzoni” Hospital-ASST Lecco, Lecco, Italy
| | - Davide Sangalli
- Neurology Unit, “A. Manzoni” Hospital-ASST Lecco, Lecco, Italy
| | | | - Andrea Salmaggi
- Neurology Unit, “A. Manzoni” Hospital-ASST Lecco, Lecco, Italy
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9
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O'Connor KP, Perez GS, Ray B, Peterson JEG, Bohnstedt BN. Histopathological examination of an embolus in infective endocarditis: Case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Elodie O, Labeyrie PE, Aubry M, Cecile D, Roux S, Ferry T, Nighoghossian N. Whipple's endocarditis diagnosed by thrombus analysis retrieved by successful mechanical thrombectomy. J Neurol Sci 2019; 400:42-43. [DOI: 10.1016/j.jns.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/26/2022]
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11
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Sotero FD, Rosário M, Fonseca AC, Ferro JM. Neurological Complications of Infective Endocarditis. Curr Neurol Neurosci Rep 2019; 19:23. [PMID: 30927133 DOI: 10.1007/s11910-019-0935-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review and update is to summarize the current knowledge and provide recent advances on the neurologic complications of infective endocarditis. RECENT FINDINGS Neurological complications occur in about one-fourth of patients with infective endocarditis. Brain MRI represents a major tool for the identification of asymptomatic lesions, which occur in most of the patients with infective endocarditis. The usefulness of systematic brain imaging and the preferred treatment of patients with infective endocarditis and silent brain lesions remains uncertain. The basis of treatment of infective endocarditis is early antimicrobial therapy. In stroke due to infective endocarditis, anticoagulation and thrombolysis should be avoided. Endovascular treatment can be useful for both acute septic emboli and mycotic aneurysms, but evidence is still limited. In patients with neurological complications, cardiac surgery can be safely performed early, if indicated. The optimal management of a patients with neurological complications of infective endocarditis needs an individualized case discussion and the participation of a multidisciplinary team including neurologists, cardiologists, cardiothoracic surgeons, neuroradiologists, neurosurgeons, and infectious disease specialists.
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Affiliation(s)
- Filipa Dourado Sotero
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Madalena Rosário
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina, Hospital de Santa Maria, Universidade de Lisboa, Neurology 6th floor, Avenida Professor Egas Moniz s/n, 1649-035, Lisbon, Portugal
| | - José M Ferro
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal. .,Faculdade de Medicina, Hospital de Santa Maria, Universidade de Lisboa, Neurology 6th floor, Avenida Professor Egas Moniz s/n, 1649-035, Lisbon, Portugal.
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12
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Wang Y, Zhao W, Lu J, Li G, Peng B, Wang H. Recurrent Acute Ischemic Stroke after Infective Endocarditis Caused by Streptococcus Constellatus : First Case Report and Analysis of the Case Series. J Stroke Cerebrovasc Dis 2018; 27:e180-e189. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/07/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022] Open
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13
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Nakanishi K, Kawano H, Amano T, Omori Y, Kanma H, Hirano T. [Stroke due to infective endocarditis diagnosed by the retrieved thrombus: a case report]. Rinsho Shinkeigaku 2018; 58:35-40. [PMID: 29269698 DOI: 10.5692/clinicalneurol.cn-001099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 80-years-old woman suddenly presented with aphasia, right hemiparesis, and dysesthesia. MRA showed the left middle cerebral artery occlusion. She was diagnosed as hyperacute ischemic stroke. She was treated with intravenous recombinant tissue plasminogen activator and underwent endovascular thrombectomy. On admission, she had a fever and high C reactive protein, and was treated with antibiotic therapy. The pathological diagnosis of the retrieved thrombus revealed the cluster of the gram positive cocci. The blood culture was negative and thransthoracic echocardiogram did not detect the vegetation. She was finally diagnosed as cardioembolic stroke due to infective endocarditis based on the pathological diagnosis of the retrieved thrombus. The pathological diagnosis of the retrieved thrombus was quite important to clarify the cause of ischemic stroke.
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Affiliation(s)
- Kaoru Nakanishi
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Tatsuo Amano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | | | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
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14
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Cantier M, Mazighi M, Klein I, Desilles JP, Wolff M, Timsit JF, Sonneville R. Neurologic Complications of Infective Endocarditis: Recent Findings. Curr Infect Dis Rep 2017; 19:41. [PMID: 28929294 DOI: 10.1007/s11908-017-0593-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to provide recent insights in management of neurologic complications of left-sided infective endocarditis (IE). RECENT FINDINGS Cerebral lesions observed in IE patients are thought to involve synergistic pathophysiological mechanisms including thromboembolism, sepsis, meningitis, and small-vessel cerebral vasculitis. Brain MRI represents a major tool for the detection of asymptomatic events occurring in the majority of patients. The latter can impact therapeutic decisions and prognosis, especially when cardiac surgery is indicated. In patients presenting with neurologic complications, surgery could be safely performed earlier than previously thought. Symptomatic cerebral ischemic or hemorrhagic events occur in 20-55% of IE patients, whereas asymptomatic events are detected in 60-80% of patients undergoing systematic brain MRI. Management of such patients requires an experienced multidisciplinary team. Recent studies suggest that early cardiac surgery, when indicated, can be performed safely in patients with cerebral ischemic events. Other important issues include the appropriate use of anti-infective and anti-thrombotic agents, and endovascular treatment for mycotic aneurysms. Altered mental status at IE onset, which is associated with brain injury, is a major determinant of short-term outcome.
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Affiliation(s)
- Marie Cantier
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France. .,INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Mikael Mazighi
- INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Isabelle Klein
- Imaging Department, Clinique Alleray Labrouste, Paris, France
| | - J P Desilles
- INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Michel Wolff
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France
| | - J F Timsit
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France. .,INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
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15
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Sveinsson O, Herrman L, Holmin S. Intra-Arterial Mechanical Thrombectomy: An Effective Treatment for Ischemic Stroke Caused by Endocarditis. Case Rep Neurol 2016; 8:229-233. [PMID: 27920715 PMCID: PMC5121560 DOI: 10.1159/000452213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/03/2016] [Indexed: 12/01/2022] Open
Abstract
Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy. We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device. From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis. Mechanical thrombectomy is most likely a more effective and safer treatment than intravenous thrombolysis in this patient group.
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Affiliation(s)
- Olafur Sveinsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Herrman
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Holmin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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16
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Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke. Stroke 2016; 47:581-641. [DOI: 10.1161/str.0000000000000086] [Citation(s) in RCA: 442] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose—
To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke.
Methods—
Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee.
Results—
After a review of the current literature, it was clearly evident that the levels of evidence supporting individual exclusion criteria for intravenous alteplase vary widely. Several exclusionary criteria have already undergone extensive scientific study such as the clear benefit of alteplase treatment in elderly stroke patients, those with severe stroke, those with diabetes mellitus and hyperglycemia, and those with minor early ischemic changes evident on computed tomography. Some exclusions such as recent intracranial surgery are likely based on common sense and sound judgment and are unlikely to ever be subjected to a randomized, clinical trial to evaluate safety. Most other contraindications or warnings range somewhere in between. However, the differential impact of each exclusion criterion varies not only with the evidence base behind it but also with the frequency of the exclusion within the stroke population, the probability of coexistence of multiple exclusion factors in a single patient, and the variation in practice among treating clinicians.
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17
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Jolobe OMP. Stigmata of Infective Endocarditis Should be Included in the Compilation of the Risk Score. J R Coll Physicians Edinb 2015. [DOI: 10.1177/147827151504500303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- OMP Jolobe
- Manchester Medical Society, Manchester, UK
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3169] [Impact Index Per Article: 352.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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19
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Kim JM, Jeon JS, Kim YW, Kang DH, Hwang YH, Kim YS. Forced arterial suction thrombectomy of septic embolic middle cerebral artery occlusion due to infective endocarditis: an illustrative case and review of the literature. Neurointervention 2014; 9:101-5. [PMID: 25426306 PMCID: PMC4239408 DOI: 10.5469/neuroint.2014.9.2.101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/21/2014] [Indexed: 11/24/2022] Open
Abstract
In acute ischemic stroke patients with major intracranial vessel occlusion due to infective endocarditis, treatment modalities are not well established. A 40-year-old woman presented with acute stroke due to left middle cerebral artery occlusion. She was successfully treated with intra-arterial mechanical thrombectomy, and the subsequent clinical outcome was favorable. Pathological analysis of the retrieved clots showed septic thrombi containing gram-positive cocci. Based on literature review and the present case regarding treatment strategies for patients with septic embolic stroke, pharmacological thrombolysis might increase the risk of hemorrhagic complications, which might alter clinical outcome. Therefore, we can consider intra-arterial mechanical thrombectomy as a first-line treatment option in patients with acute stroke resulting from infective endocarditis.
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Affiliation(s)
- Jeong-Min Kim
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea. ; School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji-Su Jeon
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea. ; School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yong-Won Kim
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea. ; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea. ; Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Korea. ; School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong-Hun Kang
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea. ; Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea. ; Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Korea. ; School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea. ; Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Korea. ; School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yong-Sun Kim
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea. ; Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Korea. ; School of Medicine, Kyungpook National University, Daegu, Korea
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20
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Abstract
Cerebrovascular diseases are one of the favorite topics of manuscripts submitted to the Journal of Neurology. In this summary paper, we briefly present those manuscripts that in our opinion were most relevant in selected areas of vascular diseases of the brain.
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Affiliation(s)
- José M Ferro
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal,
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21
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Brownlee WJ, Anderson NE, Barber PA. Intravenous thrombolysis is unsafe in stroke due to infective endocarditis. Intern Med J 2014; 44:195-7. [DOI: 10.1111/imj.12343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- W. J. Brownlee
- Department of Neurology; Auckland City Hospital; Auckland New Zealand
| | - N. E. Anderson
- Department of Neurology; Auckland City Hospital; Auckland New Zealand
| | - P. A. Barber
- Department of Neurology; Auckland City Hospital; Auckland New Zealand
- Centre for Brain Research; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
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22
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Novy E, Sonneville R, Mazighi M, Klein IF, Mariotte E, Mourvillier B, Bouadma L, Wolff M. Neurological complications of infective endocarditis: new breakthroughs in diagnosis and management. Med Mal Infect 2013; 43:443-50. [PMID: 24215865 DOI: 10.1016/j.medmal.2013.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 09/05/2013] [Accepted: 09/27/2013] [Indexed: 11/29/2022]
Abstract
Neurological complications are frequent in infective endocarditis (IE) and increase morbidity and mortality rates. A wide spectrum of neurological disorders may be observed, including stroke or transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most complications occur early during the course of IE and are a hallmark of left-sided abnormalities of native or prosthetic valves. Ischemic lesions account for 40% to 50% of IE central nervous system complications. Systematic brain MRI may reveal cerebral abnormalities in up to 80% of patients, including cerebral embolism in 50%, mostly asymptomatic. Neurological complications affect both medical and surgical treatment and should be managed by an experimented multidisciplinary team including cardiologists, neurologists, intensive care specialists, and cardiac surgeons. Oral anticoagulant therapy given to patients presenting with cerebral ischemic lesions should be replaced by unfractionated heparin for at least 2 weeks, with a close monitoring of coagulation tests. Recently published data suggest that after an ischemic stroke, surgery indicated for heart failure, uncontrolled infection, abscess, or persisting high emboli risk should not be delayed, provided that the patient is not comatose or has no severe deficit. Surgery should be postponed for 2 to 3 weeks for patients with intracranial hemorrhage. Endovascular treatment is recommended for cerebral mycotic aneurysms, if there is no severe mass effect. Recent data suggests that neurological failure, which is associated with the location and extension of brain injury, is a major determinant for short-term prognosis.
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Affiliation(s)
- E Novy
- Service de réanimation médicale et des maladies infectieuses, université Paris-Diderot, Sorbonne Paris-Cité, hôpital Bichat-Claude-Bernard, Assistance Publique-hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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