Scholarlink

Introduction <p>Acute ischemic stroke (AIS) is the most common neurological complication of infective endocarditis (IE), occurring in 20–40% of patients. In this context, while mechanical thrombectomy (MT) is the standard treatment for patients with AIS due to large-vessel occlusion (LVO), its efficacy and safety in patients with stroke secondary to IE remain unclear.</p> Objective <p>Therefore, a&#xa0;more robust analysis of the efficacy and safety of MT in patients with AIS due to IE was conducted to address the gaps identified in previous studies.</p> Methods <p>An extensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases was conducted from inception to December 2024. The endpoints of interest were: (1)&#xa0;favorable functional outcomes at 90&#xa0;days, (2)&#xa0;successful recanalization, (3)&#xa0;symptomatic intracranial hemorrhage (sICH), (4)&#xa0;any intracranial hemorrhage (aICH), and (5)&#xa0;overall mortality. The pooled proportion rates were employed with a&#xa0;random effects model with 95% Confidence Intervals (CI) and risk ratios (RR) for binary outcomes with 95% CI. I<sup>2</sup> statistics and Cochran&#xa0;Q test were performed to verify the heterogeneity.</p> Results <p>Eight studies published between 2017 and 2024 enrolled 2037 patients (mean age 57.9 years, 62.3% women), of whom 1401 (69%) received mechanical or endovascular thrombectomy for Infective Endocarditis-Related Large Vessel Occlusion (IE-LVO) stroke. A&#xa0;pooled proportion of 29.0% for favorable functional outcomes (mRS 0–2) was reported (95% CI 14.0–43.0%; I<sup>2</sup> = 65.7%). Successful recanalization (mTICI&#xa0;2b-3) was observed in 76.0% of patients (95% CI 68.0–84.0%; I<sup>2</sup> = 23.6%). sICH was reported in 19.0% (95% CI 0.0–38.0%; I<sup>2</sup> = 49.2%) and aICH in 30.0% of the patients (95% CI 23.0–38.0%; I<sup>2</sup> = 78.3%). A&#xa0;pooled proportion of 33.0% for all-cause mortality was evidenced (95% CI 21.0–45.0%; I<sup>2</sup> = 90.4%). A&#xa0;significantly lower incidence of favorable functional outcomes (mRS 0–2) was observed in patients with IE-LVO who underwent MT compared to non-IE-LVO patients (RR 0.48; 95% CI 0.31–0.75; <i>I</i><sup><i>2</i></sup> <i>=</i> <i>0.0%), </i>and no significant difference in the incidence of aICH was found between patients with IE-LVO and those with non-IE-LVO who underwent MT (RR 1.38; 95% CI 0.96–1.98; <i>I</i><sup><i>2</i></sup> <i>=</i> <i>62.4%</i>).</p> Conclusion <p>High successful recanalization rates were achieved in this population through MT, demonstrating its potential as an effective treatment for IE-LVO. However, the clinical outcomes of patients with IE-LVO were significantly unfavorable compared with those of patients without IE-LVO.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Efficacy and Safety of Mechanical Thrombectomy for Patients with Infective Endocarditis-Related Large Vessel Occlusion: a Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年8月19日

查看全文
  • Ocílio Ribeiro Gonçalves,
  • Gabriel de Almeida Monteiro,
  • Ana B. Santos,
  • Gabriel Arruda,
  • Antonio Mutarelli,
  • Gabriel Marinheiro,
  • Kleuber Arias Meireles Martins,
  • Marianna Leite,
  • Saul Dominici,
  • Társis Vinícius Cronemberger,
  • Ahmet Günkan,
  • Kelson James Almeida,
  • Marcio Yuri Ferreira,
  • Christian Ferreira,
  • David Gordon,
  • Yafell Serulle

摘要

Introduction

Acute ischemic stroke (AIS) is the most common neurological complication of infective endocarditis (IE), occurring in 20–40% of patients. In this context, while mechanical thrombectomy (MT) is the standard treatment for patients with AIS due to large-vessel occlusion (LVO), its efficacy and safety in patients with stroke secondary to IE remain unclear.

Objective

Therefore, a more robust analysis of the efficacy and safety of MT in patients with AIS due to IE was conducted to address the gaps identified in previous studies.

Methods

An extensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases was conducted from inception to December 2024. The endpoints of interest were: (1) favorable functional outcomes at 90 days, (2) successful recanalization, (3) symptomatic intracranial hemorrhage (sICH), (4) any intracranial hemorrhage (aICH), and (5) overall mortality. The pooled proportion rates were employed with a random effects model with 95% Confidence Intervals (CI) and risk ratios (RR) for binary outcomes with 95% CI. I2 statistics and Cochran Q test were performed to verify the heterogeneity.

Results

Eight studies published between 2017 and 2024 enrolled 2037 patients (mean age 57.9 years, 62.3% women), of whom 1401 (69%) received mechanical or endovascular thrombectomy for Infective Endocarditis-Related Large Vessel Occlusion (IE-LVO) stroke. A pooled proportion of 29.0% for favorable functional outcomes (mRS 0–2) was reported (95% CI 14.0–43.0%; I2 = 65.7%). Successful recanalization (mTICI 2b-3) was observed in 76.0% of patients (95% CI 68.0–84.0%; I2 = 23.6%). sICH was reported in 19.0% (95% CI 0.0–38.0%; I2 = 49.2%) and aICH in 30.0% of the patients (95% CI 23.0–38.0%; I2 = 78.3%). A pooled proportion of 33.0% for all-cause mortality was evidenced (95% CI 21.0–45.0%; I2 = 90.4%). A significantly lower incidence of favorable functional outcomes (mRS 0–2) was observed in patients with IE-LVO who underwent MT compared to non-IE-LVO patients (RR 0.48; 95% CI 0.31–0.75; I2 = 0.0%), and no significant difference in the incidence of aICH was found between patients with IE-LVO and those with non-IE-LVO who underwent MT (RR 1.38; 95% CI 0.96–1.98; I2 = 62.4%).

Conclusion

High successful recanalization rates were achieved in this population through MT, demonstrating its potential as an effective treatment for IE-LVO. However, the clinical outcomes of patients with IE-LVO were significantly unfavorable compared with those of patients without IE-LVO.