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D'Anna L, Abu-Rumeileh S, Merlino G, Ornello R, Foschi M, Diana F, Barba L, Mastrangelo V, Romoli M, Lobotesis K, Bax F, Kuris F, Valente M, Otto M, Korompoki E, Sacco S, Gigli GL, Nguyen TN, Banerjee S. Safety and Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Attributable to Cardiological Diseases: A Scoping Review. J Am Heart Assoc 2024; 13:e034783. [PMID: 38874062 DOI: 10.1161/jaha.124.034783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
There is limited evidence on the outcomes and safety of mechanical thrombectomy (MT) among patients with acute ischemic stroke (AIS) in the context of cardiac diseases. Our study reviews MT in AIS within the context of cardiac diseases, aiming to identify existing and emerging needs and gaps. PubMed and Scopus were searched until December 31, 2023, using a combination of cardiological diseases and "mechanical thrombectomy" or "endovascular treatment" as keywords. Study design included case reports/series, observational studies, randomized clinical trials, and meta-analyses/systematic reviews. We identified 943 articles, of which 130 were included in the review. Results were categorized according to the cardiac conditions. MT shows significant benefits in patients with atrial fibrillation (n=139) but lacks data for stroke occurring after percutaneous coronary intervention (n=2) or transcatheter aortic valve implantation (n=5). MT is beneficial in AIS attributable to infective endocarditis (n=34), although functional benefit may be limited. Controversy surrounds the functional outcomes and mortality of patients with AIS with heart failure undergoing MT (n=11). Despite technical challenges, MT appears feasible in aortic dissection cases (n=4), and in patients with left ventricular assist device or total artificial heart (n=10). Data on AIS attributable to congenital heart disease (n=4) primarily focus on pediatric cases requiring technical modifications. Treatment outcomes of MT in patients with cardiac tumors (n=8) vary because of clot consistency differences. After cardiac surgery stroke, MT may improve outcomes with early intervention (n=13). Available data outline the feasibility of MT in patients with AIS attributable to large-vessel occlusion in the context of cardiac diseases.
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Affiliation(s)
- Lucio D'Anna
- Department of Stroke and Neuroscience Charing Cross Hospital, Imperial College London NHS Healthcare Trust London United Kingdom
- Department of Brain Sciences Imperial College London London United Kingdom
| | - Samir Abu-Rumeileh
- Department of Neurology Martin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | - Giovanni Merlino
- Stroke Unit and Clinical Neurology Udine University Hospital Udine Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - Francesco Diana
- Interventional Neuroradiology Vall d'Hebron University Hospital Barcelona Catalunya Spain
| | - Lorenzo Barba
- Department of Neurology Martin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | | | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience Bufalini Hospital, Azienda Unità Sanitaria Locale Romagna Cesena Italy
| | - Kyriakos Lobotesis
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London NHS Healthcare Trust London United Kingdom
| | - Francesco Bax
- Philip Kistler Research Center, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Fedra Kuris
- Stroke Unit and Clinical Neurology Udine University Hospital Udine Italy
| | - Mariarosaria Valente
- Clinical Neurology Udine University Hospital and Dipartmento di Area Medica, University of Udine Udine Italy
| | - Markus Otto
- Department of Neurology Martin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | - Eleni Korompoki
- Department of Brain Sciences Imperial College London London United Kingdom
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - Gian Luigi Gigli
- Stroke Unit and Clinical Neurology Udine University Hospital Udine Italy
| | - Thanh N Nguyen
- Department of Neurology, Radiology Boston Medical Center Boston MA USA
| | - Soma Banerjee
- Department of Stroke and Neuroscience Charing Cross Hospital, Imperial College London NHS Healthcare Trust London United Kingdom
- Department of Brain Sciences Imperial College London London United Kingdom
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Marin-Cuartas M, De La Cuesta M, Weber C, Krinke E, Lichtenberg A, Petrov A, Hagl C, Aubin H, Matschke K, Diab M, Luehr M, Akhyari P, Schnackenburg P, Tugtekin SM, Saha S, Doenst T, Wahlers T, Borger MA, Misfeld M. Outcomes following heart valve surgery in patients with infective endocarditis and preoperative septic cerebral embolism: insights from the CAMPAIGN study group. Eur J Cardiothorac Surg 2024; 66:ezae295. [PMID: 39087593 DOI: 10.1093/ejcts/ezae295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/31/2024] [Accepted: 07/31/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES This study aimed to analyse the impact of preoperative septic cerebral embolism on early and late postoperative outcomes in patients with infective endocarditis undergoing valve surgery. METHODS Retrospective multicentric study based on the Clinical Multicentric Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry comprising patients with infective endocarditis who underwent valve surgery between 1994 and 2018 at 6 German centres. Patients were divided into 2 groups for statistical comparison according to the presence or absence of preoperative septic cerebral embolism. Propensity score matching was performed for adjusted comparisons of postoperative outcomes. Primary outcomes were 30-day mortality and estimated 5-year survival. RESULTS A total of 4917 patients were included in the analysis, 3909 (79.5%) patients without and 1008 (20.5%) patients with preoperative septic cerebral embolism. Patients with preoperative septic cerebral embolism had more baseline comorbidities. Mitral valve endocarditis (44.1% vs 33.0% P < 0.001), large vegetations >10 mm (43.1% vs 30.0%, P < 0.001), and Staphylococcus species infection (42.3% vs 21.3%, P < 0.001) were more frequent in the cerebral embolism group. Among patients with preoperative cerebral embolism, 286 (28.4%) patients had no stroke signs (silent stroke). After matching (1008 matched pairs), there was no statistically significant difference in 30-day mortality (20.1% vs 22.8%; P = 0.14) and 5-year survival (47.8% vs 49.1%; stratified log-rank P = 0.77) in patients with and without preoperative cerebral embolism, respectively. CONCLUSIONS Preoperative septic cerebral embolism in patients with infective endocarditis requiring valve surgery does not negatively affect early or late mortality; therefore, it should not play a major role in deciding if surgery is to be performed.
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Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Manuela De La Cuesta
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Elisabeth Krinke
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Asen Petrov
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Mahmoud Diab
- Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg, Rontenburg an der Fulda, Germany
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Payam Akhyari
- Department of Cardiothoracic Surgery, RWTH Aachen, Aachen, Germany
| | | | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, University Hospital LMU Munich, Munich, Germany
| | - Torsten Doenst
- Department of Cardiac Surgery, University Hospital of Jena, Jena, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, RPAH, Sydney, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
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3
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Buque HA, Namburete E, Vaz DC, Sebasteão FJ, Baduro Y, Rosales EL, Arroz N, Bacallao L, Pizzol D, Smith L. Septic cardioembolic stroke secondary to infective endocarditis in a young patient with rheumatic heart disease: a case report. Oxf Med Case Reports 2024; 2024:omae083. [PMID: 39119015 PMCID: PMC11304976 DOI: 10.1093/omcr/omae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/13/2024] [Accepted: 06/19/2024] [Indexed: 08/10/2024] Open
Abstract
The risk of stroke due to infective endocarditis is particularly high during the first week. Moreover, in low-resource settings where imaging access is limited, and diagnostic pathways are inaccurate the risk further increases. In addition to antibiotic therapy, treatment may include intravenous thrombolysis, with high risk of hemorrhagic complications in patients with infective endocarditis or mechanical thrombectomy. We report here a case of a 24-year-old male with rheumatic heart disease presenting a septic cardioembolic stroke secondary to infective endocarditis that was successfully treated in a low-resource setting.
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Affiliation(s)
- Helena Agostingo Buque
- Department of Neurology, Maputo Central Hospital, 1653 Avenida Eduardo Mondlane, 1100, Mozambique
| | - Evangelina Namburete
- Department of Internal Medicine, Maputo Central Hospital, 1653 Avenida Eduardo Mondlane, Maputo, 1100, Mozambique
| | - Deise Catamo Vaz
- Department of Neurology, Maputo Central Hospital, 1653 Avenida Eduardo Mondlane, 1100, Mozambique
| | - Frederico João Sebasteão
- Department of Neurology, Maputo Central Hospital, 1653 Avenida Eduardo Mondlane, 1100, Mozambique
| | - Yanina Baduro
- Department of Neurology, Maputo Central Hospital, 1653 Avenida Eduardo Mondlane, 1100, Mozambique
| | - Elder Lorenzo Rosales
- Department of Neurology, Maputo Central Hospital, 1653 Avenida Eduardo Mondlane, 1100, Mozambique
| | - Nachan Arroz
- Department of Neurology, Maputo Central Hospital, 1653 Avenida Eduardo Mondlane, 1100, Mozambique
| | - Lazara Bacallao
- Department of Neurology, Maputo Central Hospital, 1653 Avenida Eduardo Mondlane, 1100, Mozambique
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa, Beira, Rua Fernao Mendez Pinto 165, Ponta Gea, Beira, 1363, Mozambique
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Young Street, Cambridge, Cambridgeshire CB1 2LZ, United Kingdom
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Ramsay IA, Elarjani T, Govindarajan V, Silva MA, Abdelsalam A, Burks JD, Starke RM, Luther E. Concurrent bacterial endocarditis is associated with worse inpatient outcomes for large vessel occlusions. J Neurointerv Surg 2024; 16:657-662. [PMID: 37586820 DOI: 10.1136/jnis-2023-020381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/24/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Neurological complications of bacterial endocarditis (BE) are common, including acute ischemic stroke (AIS). Although mechanical thrombectomy (MT) is effective for large vessel occlusion (LVO) stroke, data are limited on MT for LVOs in patients with endocarditis. We assess outcomes in patients treated with thrombectomy for LVOs with concurrent BE. METHODS The National Inpatient Sample (NIS) was used. The NIS was queried from October 2015-2019 for patients receiving MT for LVO of the middle cerebral artery. Odds ratios (OR) were calculated using a multivariate logistic regression model. RESULTS A total of 635 AIS with BE patients and 57 420 AIS only patients were identified undergoing MT. AIS with BE patients had a death rate of 26.8% versus 10.2% in the stroke alone cohort, and were also less likely to have a routine discharge (10.2% vs 20.9%, both P<0.0001). AIS with BE patients had higher odds of death (OR 3.94) and lower odds of routine discharge (OR 0.23). AIS with BE patients also had higher rates of post-treatment cerebral hemorrhage, 39.4% vs 23.7%, with an OR of 2.20 (P<0.0001 for both analyses). These patients also had higher odds of other complications, including hydrocephalus, respiratory failure, acute kidney injury, and sepsis. CONCLUSION While MT can be used to treat endocarditis patients with LVOs, these patients have worse outcomes. Additional investigations should be undertaken to better understand their clinical course, and further develop treatments for endocarditis patients with stroke.
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Affiliation(s)
- Ian A Ramsay
- MD-MPH Program, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Turki Elarjani
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vaidya Govindarajan
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A Silva
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ahmed Abdelsalam
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua D Burks
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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5
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Caproni S, Ottavi P, Borghetti V, Taddei G, Conti C, Riva A, Di Schino C, Costantini F, Colosimo C. Transient ischemic attack and minor stroke as "surgeons affairs": a narrative review. Neurol Sci 2023; 44:4233-4245. [PMID: 37542547 DOI: 10.1007/s10072-023-06985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE The scope of this paper is to review the subtypes of transient ischemic attack (TIA) and minor stroke (mS) in which a surgical treatment is needed, discussing the importance and the timing of a multidisciplinary approach, in order to achieve an optimized management and prevent major strokes or other critical complications. MATERIALS AND METHODS The keywords "transient ischemic attack," "minor stroke," "surgical treatment," "vascular surgery," "heart surgery," "neurosurgery," and "multidisciplinary" were searched using MEDLINE, EMBASE, and Scopus. Relevant search results were discussed by the authors for references inclusion. RESULTS Notwithstanding that best medical therapy is usually the first choice for the most part of cases, there are specific but recurrent etiologies that must be properly recognized because of a potential surgical approach, even in urgency. In fact, symptomatic carotid stenosis, or particular cases of hemodynamic cerebrovascular events, should be promptly referred to vascular surgeon, since increasing evidences highlighted a benefit from an early artery revascularization. In addition, beyond arrhythmic causes, cardioembolic events due to bacterial endocarditis and atrial myxoma should be quickly diagnosed, possibly in emergency department, because they are a presumptive urgency for heart surgery. In addition to the above-mentioned conditions, in patients suffering from vertebrobasilar TIA or mS, clinicians should keep in mind the Bow Hunter disease, because surgical artery decompression can represent the only suitable treatment in selected cases. CONCLUSIONS TIA and mS require a multidisciplinary in order to discuss therapeutic options, comparing risks and benefits and determining the best timing for an optimized management.
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Affiliation(s)
- S Caproni
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - P Ottavi
- Vascular Surgery, Cardio-Thoraco-Vascular Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - V Borghetti
- Heart Surgery, Cardio-Thoraco-Vascular Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - G Taddei
- Neurosurgery, Surgery Department, "S. Maria Goretti" Hospital, Via Lucia Scaravelli, 04100, Latina, Italy
| | - C Conti
- Neurosurgery, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - A Riva
- Neurology, Medicine Department, "Università Politecnica delle Marche", Via Conca 71, 60126, Ancona, Italy
| | - Chiara Di Schino
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - F Costantini
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - C Colosimo
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 242] [Impact Index Per Article: 242.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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7
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Nedel W, Boniatti MM, Lisboa T. Endocarditis in critically ill patients: a review. Curr Opin Crit Care 2023; 29:430-437. [PMID: 37646776 DOI: 10.1097/mcc.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW To summarize the advances in literature that support the best current practices regarding infective endocarditis (IE) in critically ill patients. RECENT FINDINGS IE due to rheumatic diseases has decreased significantly, and in fact, the majority of cases are associated with degenerative valvopathies, prosthetic valves, and cardiovascular implantable electronic devices. The Duke criteria were recently updated, addressing the increasing incidence of new risk factors for IE, such as IE associated with the use of endovascular cardiac implantable electronic devices and transcatheter implant valves. The presence of organ dysfunction, renal replacement therapies, or extracorporeal membrane oxygenation should be considered in the choice of drug and dosage in critically ill patients with suspected or confirmed IE. As highlighted for other severe infections, monitoring of therapeutic antibiotic levels is a promising technique to improve outcomes in critically ill patients with organ dysfunction. SUMMARY The diagnostic investigation of IE must consider the current epidemiological criteria and the diagnostic particularities that these circumstances require. A careful evaluation of these issues is necessary for the prompt clinical or surgical management of this infection.
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Affiliation(s)
- Wagner Nedel
- Hospital de Clinicas de Porto Alegre
- Hospital Nossa Senhora Conceição
| | - Marcio Manozzo Boniatti
- Hospital de Clinicas de Porto Alegre
- Programa de Pos-Graduação Cardiologia, UFRGS
- Universidade LaSalle, Canoas
| | - Thiago Lisboa
- Hospital de Clinicas de Porto Alegre
- Universidade LaSalle, Canoas
- Programa de Pos-Graduação Ciencias Pneumológicas, UFRGS, Porto Alegre
- Hospital Santa Rita, Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
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Abstract
PURPOSE OF REVIEW Embolic stroke of undetermined source is a challenging clinical entity. While less common than atrial fibrillation and endocarditis, many noninfective heart valve lesions have been associated with stroke and may be considered as culprits for cerebral infarcts when other more common causes are excluded. This review discusses the epidemiology, pathophysiology, and management of noninfective valvular diseases that are commonly associated with stroke. RECENT FINDINGS Calcific debris from degenerating aortic and mitral valves may embolize to the cerebral vasculature causing small- or large-vessel ischemia. Thrombus which may be adherent to calcified valvular structures or left-sided cardiac tumors may also embolize resulting in stroke. Tumors themselves, most commonly myxomas and papillary fibroelastomas, may fragment and travel to the cerebral vasculature. Despite this broad differential, many types of valve diseases are highly comorbid with atrial fibrillation and vascular atheromatous disease. Thus, a high index of suspicion for more common causes of stroke is needed, especially given that treatment for valvular lesions typically involves cardiac surgery whereas secondary prevention of stroke due to occult atrial fibrillation is readily accomplished with anticoagulation.
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Affiliation(s)
- Jacob J Mayfield
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Catherine M Otto
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
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9
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Hurford R, Siripurapu R, Emsley HCA, Lovett J, Werring D, Punter MNM. Uncommon causes of ischaemic stroke: how to approach the diagnosis. Pract Neurol 2023; 23:35-45. [PMID: 35863878 DOI: 10.1136/pn-2022-003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 02/02/2023]
Abstract
Stroke is a common neurological emergency and although most cases are associated with traditional vascular risk factors leading to cerebral ischaemia by well-recognised pathophysiological mechanisms, around 4% of ischaemic strokes are due to rare conditions. These are important to recognise due to their different management, which is often specific and effective, and due to their different prognosis from otherwise cryptogenic ischaemic strokes. We outline a practical approach to identifying uncommon causes of ischaemic stroke by highlighting diagnostic 'red flags' and propose a structured approach to investigating them.
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Affiliation(s)
- Robert Hurford
- Neurology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rekha Siripurapu
- Department of Neuroradiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Joanna Lovett
- Neurology Department, Wessex Neurological Centre, Southampton, UK
| | - David Werring
- Stroke Research Group, UCL institute of neurology, London, UK
| | - Martin Nicholas Michael Punter
- Department of Medicine, University of Otago, Wellington, New Zealand .,Department of Neurology, Wellington Regional Hospital, Newtown, New Zealand
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10
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Endovascular Treatment of Large Vessel Occlusion Strokes Caused by Infective Endocarditis: A Systematic Review, Meta-Analysis, and Case Presentation. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122146. [PMID: 36556511 PMCID: PMC9780851 DOI: 10.3390/life12122146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Thromboembolic events such as acute ischemic strokes are frequently seen in patients with infective endocarditis (IE). It is generally recommended that the administration of intravenous thrombolytics is avoided in these patients as they might encounter a higher risk of intracranial hemorrhages. In this setting, particularly with a large vessel occlusion (LVO), a mechanical thrombectomy may be an alternative option. In this systematic review and meta-analysis, we aimed to investigate the outcomes and safety of mechanical thrombectomies for LVO stroke patients secondary to IE. A search strategy was developed and we searched PubMed, Scopus, Web of Sciences, and Embase using the words "infective endocarditis", "stroke", and "mechanical thrombectomy". Including 6 studies and 120 patients overall, this study showed that a mechanical thrombectomy might reduce the National Institute of Health Stroke Scale (NIHSS), with a weighted mean difference of -3.06 and a 95% CI of -4.43 to -1.70. The pooled rate of symptomatic intracranial hemorrhages and all-cause mortality were also determined to be 15% (95% CI: 4-47%) and 34% (95% CI:14-61%), respectively. The results of this study showed that a mechanical thrombectomy might be an effective and reasonably safe option for the treatment of LVO strokes caused by IE. However, more large-scale studies are needed to consolidate these results.
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11
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Lakbar I, Delamarre L, Einav S, Leone M. Endocarditis in the intensive care unit: an update. Curr Opin Crit Care 2022; 28:503-512. [PMID: 35942691 DOI: 10.1097/mcc.0000000000000973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The incidence of infective endocarditis (IE) is increasing worldwide, resulting in a higher number of patients with IE being admitted to intensive care units (ICU). Nearly half of patients with IE develop a complication during their clinical course. However, few well conducted studies or reviews are devoted to critically ill IE patients. This review discusses the contemporary perioperative and intensive care literature. RECENT FINDINGS IE epidemiology is changing towards elderly and frail patients. ICU patients are at risk of risk of developing IE because they are often in a pro-inflammatory state and many also have several indwelling catheters, which favors infection. Increased performance and recent advances in cardiac imaging allow for easier diagnosis of EI, but the applicability of these techniques to ICU patients is still relatively limited. New developments in antibiotic treatment and adjunctive therapies are explored further in this review. SUMMARY The lack of evidence on ICU patients with IE highlights the critical importance of multidisciplinary decision-making and the need for further research.
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Affiliation(s)
- Ines Lakbar
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France
| | - Louis Delamarre
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France
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12
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Optimal Timing for Cardiac Surgery in Infective Endocarditis with Neurological Complications: A Narrative Review. J Clin Med 2022; 11:jcm11185275. [PMID: 36142922 PMCID: PMC9501443 DOI: 10.3390/jcm11185275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
In patients with infective endocarditis and neurological complications, the optimal timing for cardiac surgery is unclear due to the varied risk of clinical deterioration when early surgery is performed. The aim of this review is to summarize the best evidence on the optimal timing for cardiac surgery in the presence of each type of neurological complication. An English literature search was carried out from June 2018 through July 2022. The resulting selection, comprising observational studies, clinical trials, systematic reviews and society guidelines, was organized into four sections according to the four groups of neurological complications: ischemic, hemorrhagic, infectious, and asymptomatic complications. Cardiac surgery could be performed without delay in cases of ischemic vascular neurological complication (provided the absence of severe damage, which can be avoided with the performance of mechanical thrombectomy in cases of major stroke), as well as infectious or asymptomatic complications. In the presence of intracranial hemorrhage, a delay of four weeks is recommended for most cases, although recent studies have suggested that performing cardiac surgery within four weeks could be a suitable option for selected cases. The findings of this review are mostly in line with the recommendations of the current European and American infective endocarditis guidelines.
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Maheshwari R, Cordato DJ, Wardman D, Thomas P, Bhaskar SMM. Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review. J Cent Nerv Syst Dis 2022; 14:11795735221081597. [PMID: 35282315 PMCID: PMC8905057 DOI: 10.1177/11795735221081597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/02/2022] [Indexed: 01/08/2023] Open
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.
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Affiliation(s)
- Rohan Maheshwari
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Dennis J. Cordato
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Daniel Wardman
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Peter Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Sonu M. M. Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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14
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Abstract
The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.
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Ikeuchi Y, Ashida N, Nishihara M, Hosoda K. Successful Thrombectomy for Endocarditis-Related Stroke in a Very Young Patient: Illustrative Case. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:402-408. [PMID: 37502633 PMCID: PMC10370630 DOI: 10.5797/jnet.cr.2021-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/08/2021] [Indexed: 07/29/2023]
Abstract
Objective Unlike in older adults, ischemic stroke in young patients occurs secondary to preexisting conditions. Infective endocarditis (IE) is among the most important causes of stroke in young adults and has a severe prognosis. There are few reports of mechanical thrombectomy (MT) for IE-induced large-vessel occlusion (LVO). This paper reports a case of acute IE-induced LVO in a young patient who was successfully treated with MT. Case Presentation An 18-year-old woman presented to our hospital with severe headache, high fever, and left fingertip pain. She was admitted to the Department of Neurology for conservative treatment of suspected meningitis. On day 2 of admission, she developed acute left hemiparesis, left hemispatial neglect, and dysarthria. MRA showed occlusion of the right M1 segment of the middle cerebral artery, and the patient immediately underwent MT. After a single pass, we achieved thrombolysis in cerebral infarction 2b. A white clot was diagnosed as a vegetation on pathological examination. As transesophageal echocardiography showed a vegetation on the mitral valve, the patient was diagnosed with IE and underwent cardiovascular surgery. The patient recovered well and underwent additional treatment and rehabilitation. Conclusion Although rare, IE-induced septic emboli may occur in young patients with LVO, necessitating MT and pathological diagnosis of the clot.
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Affiliation(s)
- Yusuke Ikeuchi
- Division of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
| | - Noriaki Ashida
- Division of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
| | | | - Kohkichi Hosoda
- Division of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
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Kelley RE, Kelley BP. Heart-Brain Relationship in Stroke. Biomedicines 2021; 9:biomedicines9121835. [PMID: 34944651 PMCID: PMC8698726 DOI: 10.3390/biomedicines9121835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
The patient presenting with stroke often has cardiac-related risk factors which may be involved in the mechanism of the stroke. The diagnostic assessment is predicated on recognition of this potential relationship. Naturally, an accurate history is of utmost importance in discerning a possible cause and effect relationship. The EKG is obviously an important clue as well as it allows immediate assessment for possible cardiac arrhythmia, such as atrial fibrillation, for possible acute ischemic changes reflective of myocardial ischemia, or there may be indirect factors such as the presence of left ventricular hypertrophy, typically seen with longstanding hypertension, which could be indicative of a hypertensive mechanism for a patient presenting with intracerebral hemorrhage. For all presentations in the emergency room, the vital signs are important. An elevated body temperature in a patient presenting with acute stroke raises concern about possible infective endocarditis. An irregular-irregular pulse is an indicator of atrial fibrillation. A markedly elevated blood pressure is not uncommon in both the acute ischemic and acute hemorrhagic stroke setting. One tends to focus on possible cardioembolic stroke if there is the sudden onset of maximum neurological deficit versus the stepwise progression more characteristic of thrombotic stroke. Because of the more sudden loss of vascular supply with embolic occlusion, seizure or syncope at onset tends to be supportive of this mechanism. Different vascular territory involvement on neuroimaging is also a potential indicator of cardioembolic stroke. Identification of a cardiogenic source of embolus in such a setting certainly elevates this mechanism in the differential. There have been major advances in management of acute cerebrovascular disease in recent decades, such as thrombolytic therapy and endovascular thrombectomy, which have somewhat paralleled the advances made in cardiovascular disease. Unfortunately, the successful limitation of myocardial damage in acute coronary syndrome, with intervention, does not necessarily mirror a similar salutary effect on functional outcome with cerebral infarction. The heart can also affect the brain from a cerebral perfusion standpoint. Transient arrhythmias can result in syncope, while cardiac arrest can result in hypoxic-ischemic encephalopathy. Cardiogenic dementia has been identified as a mechanism of cognitive impairment associated with severe cardiac failure. Structural cardiac abnormalities can also play a role in brain insult, and this can include tumors, such as atrial myxoma, patent foramen ovale, with the potential for paradoxical cerebral embolism, and cardiomyopathies, such as Takotsubo, can be associated with precipitous cardioembolic events.
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Affiliation(s)
- Roger E. Kelley
- Ochsner/LSU Health Sciences Center, Department of Neurology, Shreveport, LA 71130, USA
- Correspondence:
| | - Brian P. Kelley
- Division of Cardiology, Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA;
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17
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Acute Ischaemic Stroke in Infective Endocarditis: Pathophysiology and Clinical Outcomes in Patients Treated with Reperfusion Therapy. IMMUNO 2021. [DOI: 10.3390/immuno1040023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Infective endocarditis in the setting of acute stroke poses a clinical challenge given the high mortality and morbidity associated with the condition. The pathophysiological mechanisms including clinical and imaging biomarkers that can provide insights into clinical trajectories of such patients are of immense interest. The current paper aims to provide a comprehensive overview of acute stroke with infective endocarditis and provide insights into various clinical factors mediating outcomes and therapeutic strategies, specifically in the setting of reperfusion therapy. Prognostic and therapeutic pathways to potentially improve functional outcomes in these patients are also discussed.
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Chen Z, Fan T, Zhao X, Zhang Z. Depleting SOX2 improves ischemic stroke via lncRNA PVT1/microRNA-24-3p/STAT3 axis. Mol Med 2021; 27:107. [PMID: 34521353 PMCID: PMC8439026 DOI: 10.1186/s10020-021-00346-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives Studies have widely explored in the filed of ischemic stroke (IS) with their focus on transcription factors. However, few studies have pivoted on sex determining region Y-box 2 (SOX2) in IS. Thus, this study is launched to figure out the mechanisms of SOX2 in IS. Methods Rat middle cerebral artery occlusion (MCAO) was established as a stroke model. MCAO rats were injected with depleted SOX2 or long non-coding RNA plasmacytoma variant translocation 1 (PVT1) to explore their roles in neurological deficits, cerebral water content, neuron survival, apoptosis and oxidative stress. The relationship among SOX2, PVT1, microRNA (miR)-24-3p and signal transducer and activator of transcription 3 (STAT3) was verified by a series of experiments. Results SOX2, PVT1 and STAT3 were highly expressed while miR-24-3p was poorly expressed in cerebral cortex tissues of MCAO rats. Depleted SOX2 or PVT1 alleviated brain injury in MCAO rats as reflected by neuronal apoptosis and oxidative stress restriction, brain water content reduction, and neurological deficit and neuron survival improvements. Overexpression of PVT1 functioned oppositely. Restored miR-24-3p abolished PVT1 overexpression-induced brain injury in MCAO rats. SOX2 directly promoted PVT1 expression and further increased STAT3 by sponging miR-24-3p. Conclusion This study presents that depleting SOX2 improves IS via PVT1/miR-24-3p/STAT3 axis which may broaden our knowledge about the mechanisms of SOX2/PVT1/miR-24-3p/STAT3 axis and provide a reference of therapy for IS.
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Affiliation(s)
- Zhongjun Chen
- Neurological Intervention Department, Dalian Municipal Central Hospital, Dalian, 116033, Liaoning, China
| | - Tieping Fan
- Neurological Intervention Department, Dalian Municipal Central Hospital, Dalian, 116033, Liaoning, China
| | - Xusheng Zhao
- Neurological Intervention Department, Dalian Municipal Central Hospital, Dalian, 116033, Liaoning, China
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19
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Vinacci G, Tcheumeni CN, Coskun O, Saddiki FZ, Maria FD, Dinu M, Rodesch G, Billy C, Lapergue B, Ille O, Consoli A. White thrombus as a possible feature of atypical stroke etiology: Coxiella burnetii as the primary cause of acute ischemic stroke. Interv Neuroradiol 2021; 28:142-144. [PMID: 34053317 DOI: 10.1177/15910199211021716] [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: 11/15/2022] Open
Abstract
Acute ischemic stroke (AIS) is the most common neurologic complication of infective endocarditis. We describe a singular case report of a 62- year-old male with AIS related to the occlusion of the left middle cerebral artery. Thrombus-aspiration allowed retrieving a 6 millimeters white thrombus. The real-time polymerase chain reaction performed on the thrombus detected Coxiella Burnetii allowed the diagnosis of infective endocarditis (IE) and the identification of the specific pathogen. Coxiella Burnetii is an endemic, small, intracellular, gram-negative coccobacillus and it is a rare cause of IE. The management of AIS caused by IE remains controversial, although in the cases of major occlusion mechanical thrombectomy is associated with better clinical outcomes. IE patients could not present symptoms and signs related to the infection, therefore we underline the importance of the microbiological analysis of the retrieved thrombi especially when atypical etiology is suspected.
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Affiliation(s)
| | | | - Oguzhan Coskun
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | | | - Federico Di Maria
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Mugurel Dinu
- Neurology and Stroke Unit, François Quesnay, Mantes-la-Jolie, France
| | - Georges Rodesch
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
| | - Christophe Billy
- Internal Medicine, Infectious and Tropical Diseases Department, François Quesnay Hospital, Mantes-la-Jolie, France
| | | | - Olivier Ille
- Neurology and Stroke Unit, François Quesnay, Mantes-la-Jolie, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
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20
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Tsivgoulis G, Kargiotis O, De Marchis G, Kohrmann M, Sandset EC, Karapanayiotides T, de Sousa DA, Sarraj A, Safouris A, Psychogios K, Vadikolias K, Leys D, Schellinger PD, Alexandrov AV. Off-label use of intravenous thrombolysis for acute ischemic stroke: a critical appraisal of randomized and real-world evidence. Ther Adv Neurol Disord 2021; 14:1756286421997368. [PMID: 33737956 PMCID: PMC7934037 DOI: 10.1177/1756286421997368] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Intravenous thrombolysis (IVT) represents the only systemic reperfusion therapy able to reverse neurological deficit in patients with acute ischemic stroke (AIS). Despite its effectiveness in patients with or without large vessel occlusion, it can be offered only to a minority of them, because of the short therapeutic window and additional contraindications derived from stringent but arbitrary inclusion and exclusion criteria used in landmark randomized controlled clinical trials. Many absolute or relative contraindications lead to disparities between the official drug label and guidelines or expert recommendations. Based on recent advances in neuroimaging and evidence from cohort studies, off-label use of IVT is increasingly incorporated into the daily practice of many stroke centers. They relate to extension of therapeutic time windows, and expansion of indications in co-existing conditions originally listed in exclusion criteria, such as use of alternative thrombolytic agents, pre-treatment with antiplatelets, anticoagulants or low molecular weight heparins. In this narrative review, we summarize recent randomized and real-world data on the safety and efficacy of off-label use of IVT for AIS. We also make some practical recommendations to stroke physicians regarding the off-label use of thrombolytic agents in complex and uncommon presentations of AIS or other conditions mimicking acute cerebral ischemia. Finally, we provide guidance on the risks and benefits of IVT in numerous AIS subgroups, where equipoise exists and guidelines and treatment practices vary.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, Iras 39, Gerakas Attikis, Athens 15344, Greece
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Gianmarco De Marchis
- Neurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Martin Kohrmann
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | | | - Theodore Karapanayiotides
- Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diana Aguiar de Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Amrou Sarraj
- Department of Neurology, The University of Texas at Houston, Houston, TX, USA
| | - Apostolos Safouris
- Second Department of Neurology, National & Kapodistiran University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
- Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | | | - Konstantinos Vadikolias
- Department of Neurology, University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece
| | - Didier Leys
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), Lille, France
| | - Peter D. Schellinger
- Department of Neurology, Johannes Wesling Medical Center Minden, UK RUB Minden, Germany
| | - Andrei V. Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
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21
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Charbonnier G, Bonnet L, Biondi A, Moulin T. Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke. Front Neurol 2021; 11:629920. [PMID: 33633661 PMCID: PMC7900408 DOI: 10.3389/fneur.2020.629920] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022] Open
Abstract
Intracranial hemorrhage is one of the most feared complications following brain infarct. Ischemic tissues have a natural tendency to bleed. Moreover, the first recanalization trials using intravenous thrombolysis have shown an increase in mild to severe intracranial hemorrhage. Symptomatic intracerebral hemorrhage is strongly associated with poor outcomes and is an important factor in recanalization decisions. Stroke physicians have to weigh the potential benefit of recanalization therapies, first, with different risks of intracranial hemorrhage described in randomized controlled trials, and second with numerous risk markers that have been found to be associated with intracranial hemorrhage in retrospective series. These decisions have become quite complex with different intravenous thrombolytics and mechanical thrombectomy. This review aims to outline some elements of the pathophysiological mechanisms and classifications, describe most of the risk factors identified for each reperfusion therapy, and finally suggest future research directions that could help physicians dealing with these complications.
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Affiliation(s)
- Guillaume Charbonnier
- Neurology Department, Besançon University Hospital, Besançon, France.,Interventional Neuroradiology Department, Besançon University Hospital, Besançon, France.,EA 481 Neurosciences laboratory, Franche-Comté University, Besançon, France
| | - Louise Bonnet
- Neurology Department, Besançon University Hospital, Besançon, France
| | - Alessandra Biondi
- Interventional Neuroradiology Department, Besançon University Hospital, Besançon, France.,CIC-1431 Inserm, Besançon, France
| | - Thierry Moulin
- Neurology Department, Besançon University Hospital, Besançon, France.,EA 481 Neurosciences laboratory, Franche-Comté University, Besançon, France.,CIC-1431 Inserm, Besançon, France
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22
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Tsai MJ, Liou DY, Chu YC, Chen Y, Huang MC, Huang WC, Cheng H, Tsai SK, Huang SS. Minocycline exhibits synergism with conditioned medium of bone marrow mesenchymal stem cells against ischemic stroke. J Tissue Eng Regen Med 2021; 15:279-292. [PMID: 33470523 DOI: 10.1002/term.3171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022]
Abstract
Several lines of evidence show that a conditioned medium of bone marrow mesenchymal stem cells (BM-MSCcm) improve functional recovery after ischemic stroke but do not reduce ischemic lesions. It is important to develop a treatment strategy that can exhibit a synergistic effect with BM-MSCcm against ischemic stroke. In this study, the effect of BM-MSCcm and/or minocycline was examined in culture and in a middle cerebral artery occlusion (MCAo) animal model. In neuron-glial cultures, BM-MSCcm and combined treatment, but not minocycline, effectively increased neuronal connection and oligodendroglial survival. In contrast, minocycline and combined treatment, but not BM-MSCcm, reduced toxin-induced free radical production in cultures. Either minocycline or BM-MSCcm, or in combination, conferred protective effects against oxygen glucose deprivation-induced cell damage. In an in vivo study, BM-MSCcm and minocycline were administered to rats 2 h after MCAo. Monotherapy with BM-MSCcm or minocycline after ischemic stroke resulted in 9.4% or 17.5% reduction in infarction volume, respectively, but there was no significant difference. Interestingly, there was a 33.9% significant reduction in infarction volume by combined treatment with BM-MSCcm and minocycline in an in vivo study. The combined therapy also significantly improved grasping power, which was not altered by monotherapy. Furthermore, combined therapy increased the expression of neuronal nuclei in the peri-infarct area and hippocampus, and concurrently decreased the expression of ED1 in rat brain and the peri-infarct zone. Our data suggest that minocycline exhibits a synergistic effect with BM-MSCcm against ischemic stroke not only to improve neurological functional outcome but also to reduce cerebral infarction.
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Affiliation(s)
- May-Jywan Tsai
- Department of Neurosurgery, Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Dann-Ying Liou
- Department of Neurosurgery, Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi Chen
- Department of Neurosurgery, Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chao Huang
- Department of Neurosurgery, Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Neural Regeneration, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.,Center for Neural Regeneration, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shen-Kou Tsai
- Department of Anesthesiology, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Shiang-Suo Huang
- Department of Pharmacology and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
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23
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Be aware: COVID-19 the new stroke mimicker. Acta Neurol Belg 2021; 121:309-310. [PMID: 33200353 PMCID: PMC7669261 DOI: 10.1007/s13760-020-01543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022]
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24
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Feil K, Küpper C, Tiedt S, Dimitriadis K, Herzberg M, Dorn F, Liebig T, Dieterich M, Kellert L. Safety and efficacy of mechanical thrombectomy in infective endocarditis: A matched case-control analysis from the German Stroke Registry-Endovascular Treatment. Eur J Neurol 2021; 28:861-867. [PMID: 33327038 DOI: 10.1111/ene.14686] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Up to 30% of infective endocarditis (IE) patients have ischemic stroke as a complication. Standard treatment with mechanical thrombectomy (MT) with or without intravenous thrombolysis 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 June 2015 and December 2019 were analyzed. Patients with stroke due to IE and patients with cardioembolic stroke and atrial fibrillation (AF) were compared using propensity score matching. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction 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 premorbid mRS (pmRS) = 1, interquartile range [IQR] = 0-1, National Institutes of Health Stroke Scale [NIHSS] = 15, IQR = 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, IQR = 0-2, NIHSS = 16, IQR = 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% vs. 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% vs. 28.8%, p < 0.001). IE was strongly associated with poor outcome (odds ratio [OR] = 0.32, 95% confidence interval [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 poor outcome.
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Affiliation(s)
- Katharina Feil
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Neurology and Stroke, Eberhard Karls University Tübingen/Universitätsklinikum Tübingen, Tübingen, Germany
| | - Clemens Küpper
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Konstantinos Dimitriadis
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Moriz Herzberg
- Department of Radiology, University Hospital, Würzburg, Germany.,Institute of Neuroradiology, Ludwig Maximilians University, Munich, Germany
| | - Franziska Dorn
- Institute of Neuroradiology, Ludwig Maximilians University, Munich, Germany.,Department of Neuroradiology, University of Bonn, Bonn, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, Ludwig Maximilians University, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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25
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Gopal M, Lakhani S, Lee VH. Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Unsuspected Infective Endocarditis. J Stroke Cerebrovasc Dis 2020; 30:105502. [PMID: 33360518 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/04/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Infective endocarditis (IE) is considered to be an absolute contraindication for intravenous tissue plasminogen activator treatment (IVtPA) in acute ischemic stroke (AIS). However, during the hyperacute stroke evaluation, the exclusion of IE may be difficult. We sought to report the prevalence of undiagnosed IE in AIS patients who received IVtPA. METHODS We reviewed consecutive patients hospitalized at our comprehensive stroke center from January 1, 2014 to March 31, 2019 who received IVtPA for suspected AIS and identified patients diagnosed with IE. Data was abstracted on demographics, medical history, clinical presentation, last known normal (LKN) time, initial National Institutes of Health Stroke Scale (NIHSS), neuroimaging, culture results, and 90 day modified Rankin Scale (mRS). Good functional outcome was defined as mRS ≤ 2. RESULTS Among 1022 AIS patients who received IVtPA, 5 patients (0.5%) were ultimately diagnosed with IE. Among the 5 patients with IE, the mean age was 53.4 years (range, 25-74) and 3 (60%) were female. The majority 4 (80%) were white. Medical risk factors for IE were present in 3 (60%) and included intravenous drug use (1) and dialysis (2). Initial NIHSS was 4.6 (range, 1 to 8). Fever was present on initial presentation in only 1 patient (102.7 F). The mean time from LKN to IVtPA was 3.0 hours (range, 1.9 to 4.4). Vascular imaging showed middle cerebral artery (MCA) occlusion in 4 (80%) and no occlusion in 1 (20%). One patient underwent endovascular thrombectomy. Two patients (40%) developed hemorrhagic complications, including 1 patient who developed subarachnoid hemorrhage due to mycotic cerebral aneurysm rupture. Blood culture results included MRSE (1), Streptococcus viridans (2) and negative (2). TEE in all patients showed vegetations on the mitral valve. No patients had good functional outcomes, and the mean 3 month mRS was 4.8 (range, 3 to 6). The 90 day mortality was 60%. CONCLUSION In a series of AIS patients who received IVtPA by academic vascular neurologists, the risk of undiagnosed IE was low (0.5%). Fever was not commonly present during initial evaluation in IE presenting with AIS. Despite affecting younger patients with initial mild deficits, AIS patients with IE who received IVtPA had poor functional outcomes.
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Affiliation(s)
- Mangala Gopal
- Department of Neurology, The Ohio State University Wexner Medical Center, 333 West 10(th) Avenue, Suite 3172D, Columbus, OH 43210, United States.
| | - Sushil Lakhani
- Department of Neurology, The Ohio State University Wexner Medical Center, 333 West 10(th) Avenue, Suite 3172D, Columbus, OH 43210, United States.
| | - Vivien H Lee
- Department of Neurology, The Ohio State University Wexner Medical Center, 333 West 10(th) Avenue, Suite 3172D, Columbus, OH 43210, United States.
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26
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D'Anna L. Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature. Neurol Sci 2020; 41:3517-3525. [PMID: 32700224 PMCID: PMC7655561 DOI: 10.1007/s10072-020-04599-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mechanical thrombectomy is the standard of care, in selected patients, for acute ischemic stroke with large vessel occlusion but its use in patients with stroke secondary to infective endocarditis is controversial. We report three cases of acute ischemic stroke treated by mechanical thrombectomy and we propose an extensive review of the literature to evaluate the clinical safety and efficacy of thrombectomy in patients with stroke secondary to infective endocarditis. METHODS A comprehensive literature search was performed following a pre-specified protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Case reports, cases series, cross-sectional studies, case control studies, randomized controlled trials or nonrandomized controlled trials were considered that included endocarditis-related acute ischemic stroke patients who underwent mechanical thrombectomy. RESULTS The database search yielded 431 relevant records published until January 2020. Nineteen articles fulfilled the eligibility criteria that described thirty patients. After the thrombectomy, 13.3% of the patients experienced intracranial haemorrhage. After the procedure, the median National Institutes of Health Stroke Scale score dropped from 15 (IQR 7) to 2.5 (IQR 5.75). At 90 days, mortality was 23.3% while 46.7% of the patients were functionally independent (mRS ≤ 2). DISCUSSION Based on our review, the use of mechanical thrombectomy in patients with large vessel occlusion due to endocarditis-associated stroke might improve patient outcome but it should be considered on a case by case base as the safety has not been well established yet. Further research on risk stratification is needed to drive clinician during the decision-making process.
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Affiliation(s)
- Lucio D'Anna
- Department of Stroke and Neurosciences, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK.
- Division of Brain Sciences, Imperial College London, London, UK.
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27
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Yang Y, Qidwai U, Burton BJL, Canepa C. Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct. BMJ Case Rep 2020; 13:13/11/e238422. [PMID: 33148560 PMCID: PMC7643481 DOI: 10.1136/bcr-2020-238422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.
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Affiliation(s)
- Yunfei Yang
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Umair Qidwai
- James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Benjamin J L Burton
- James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Carlo Canepa
- James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
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28
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Ramos C, Mayo P, Trillo S, Gómez-Escalonilla C, Caniego JL, Moreu M, Vega J, Rosati S, Simal P, Carrillo ÁX, Egido JA, Vivancos J. Management of Large Vessel Occlusion Stroke Related to Infective Endocarditis: Is Mechanical Thrombectomy a Safe Option? J Stroke Cerebrovasc Dis 2020; 29:105248. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022] Open
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29
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Bonaros N, Czerny M, Pfausler B, Müller S, Bartel T, Thielmann M, Shehada SE, Folliguet T, Obadia JF, Holfeld J, Lorusso R, Parolari A, Müller L, Grimm M, Ruttmann-Ulmer E. Infective endocarditis and neurologic events: indications and timing for surgical interventions. Eur Heart J Suppl 2020; 22:M19-M25. [PMID: 33664636 PMCID: PMC7916418 DOI: 10.1093/eurheartj/suaa167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A therapeutic dilemma arises when infective endocarditis (IE) is complicated by a neurologic event. Postponement of surgery up to 4 weeks is recommended by the guidelines, however, this negatively impacts outcomes in many patients with an urgent indication for surgery due to uncontrolled infection, disease progression, or haemodynamic deterioration. The current literature is ambiguous regarding the safety of cardiopulmonary bypass in patients with recent neurologic injury. Nevertheless, most publications demonstrate a lower risk for secondary haemorrhagic conversion of uncomplicated ischaemic lesions than the risk for recurrent embolism under antibiotic treatment. Here, we discuss the current literature regarding neurologic stroke complicating IE with an indication for surgery.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Silvana Müller
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Bartel
- Department of Cardiology Mediclinic City, Hospital Dubai, Dubai, United Arab Emirates
| | - Matthias Thielmann
- Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany
| | - Sharaf-Eldin Shehada
- Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany
| | - Thierry Folliguet
- Department of Cardiac Surgery and Transplantation, Henry Mondor Hospital, Paris, France
| | - Jean-Francois Obadia
- Department of Cardiac Surgery and Transplantation, Louis Pradel Hospital, Lyon, France
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maaastricht, The Netherlands
| | | | - Ludwig Müller
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Elfriede Ruttmann-Ulmer
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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30
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Si W, Li Z, Huang Z, Ye S, Li X, Li Y, Kuang W, Chen D, Zhu M. RNA Binding Protein Motif 3 Inhibits Oxygen-Glucose Deprivation/Reoxygenation-Induced Apoptosis Through Promoting Stress Granules Formation in PC12 Cells and Rat Primary Cortical Neurons. Front Cell Neurosci 2020; 14:559384. [PMID: 32982696 PMCID: PMC7492797 DOI: 10.3389/fncel.2020.559384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022] Open
Abstract
As a sensitive cold-shock protein, RNA binding protein motif 3 (RBM3) exhibits a neuroprotective function in the condition of brain injury. However, how RBM3 is involved in acute ischemic stroke by affecting stress granules (SGs) remains unclear. Here, we established an oxygen-glucose deprivation/reperfusion (OGD/R) model in rat primary cortical neurons and PC12 cells to explore the potential mechanism between RBM3 and SG formation in acute ischemic/reperfusion (I/R) condition. The immunofluorescence results showed that the SG formation significantly decreased in rat primary cortical neurons and PC12 cells during the reperfusion period after 6 h of OGD stimulation. The western blot results, flow cytometry analysis, and cell viability assessment showed that the RBM3 expression and ratio of cell viability significantly decreased, while the rate of apoptosis increased in PC12 cells during the reperfusion period after 6 h of OGD stimulation. Co-immunoprecipitation (Co-IP) and immunofluorescence indicated that RBM3 and GTPase-activating protein-binding protein 1 (G3BP1) colocalized cytoplasm of PC12 cells after 6 h of OGD stimulation when the SGs formation reached the highest level. Besides, overexpression and knockdown of the RBM3 were achieved via plasmid transfection and CRISPR-Cas9 technology, respectively. The results of overexpression and knockdown of RBM3 gene illustrated the pivotal role of RBM3 in affecting SG formation and apoptosis level in OGD-treated PC12 cells. In conclusion, RBM3 could combine with G3BP1 resulted in increasing stress granules generation in rat primary cortical neurons and PC12 cells after 6 h of oxygen-glucose deprivation (OGD) injury, which ultimately reduced the apoptosis in OGD-induced cells. Our study may enable a new promising target for alleviating ischemia-reperfusion injury in cells.
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Affiliation(s)
- Wenwen Si
- Shenzhen Bao'an Traditional Chinese Medicine Hospital (Group), Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zhen Li
- Department of Anatomy, The Research Center of Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zifeng Huang
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Shanyu Ye
- Department of Anatomy, The Research Center of Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinrong Li
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yi Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weihong Kuang
- Guangdong Key Laboratory for Research and Development of Natural Drugs, Key Laboratory of Research and Development of New Medical Materials of Guangdong Medical University, School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Dongfeng Chen
- Department of Anatomy, The Research Center of Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Meiling Zhu
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou University of Chinese Medicine, Shenzhen, China
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31
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Safety and Efficacy of Thrombolysis and Mechanical Thrombectomy in Infective Endocarditis. J Stroke Cerebrovasc Dis 2020; 29:104784. [PMID: 32205025 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 12/22/2022] Open
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