J Korean Med Sci.  2013 Aug;28(8):1244-1247. 10.3346/jkms.2013.28.8.1244.

Effectiveness of Mechanical Embolectomy for Septic Embolus in the Cerebral Artery Complicated with Infective Endocarditis

• Kang G
• Yang TK
• Choi JH
• Heo ST

• KMID: 1793033
• DOI: http://doi.org/10.3346/jkms.2013.28.8.1244

Abstract

There has been a controversy over data of thrombolytic and endovascular surgical treatment about cerebral infarction secondary to infective endocarditis. We report a woman who received early mechanical embolectomy as a treatment of acute stroke with infective endocarditis. A 35-yr-old woman was hospitalized due to right hemiparesis. Brain image showed cerebral infarction at the middle cerebral artery and echocardiography demonstrated vegetation at the mitral valve. She was successfully treated with embolectomy and parenteral antibiotics without any neurologic sequelae. This report shows that the early retrieve of septic cerebral emboli can be a helpful treatment of acute stroke associated with endocarditis.

Keyword

Mechanical Embolectomy; Acute Ischemic Stroke; Infective Endocarditis

MeSH Terms

Adult
Anti-Bacterial Agents/therapeutic use
Cerebral Arteries/radiography/*surgery
Embolectomy
Endocarditis/complications/*diagnosis/drug therapy
Female
Humans
Intracranial Embolism/surgery
Mitral Valve/ultrasonography
Streptococcus/isolation & purification
Stroke/*diagnosis/etiology/surgery
Tomography, X-Ray Computed
Anti-Bacterial Agents

Figure

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  Fig. 1 The change of signal intensity of the left middle cerebral artery in brain magnetic resonance image (MRI). (A) MRI shows hyperintensity in diffusion-weighted image (arrow). (B) The image shows perfusion delay in mean transit time. (C) Time to peak maps of the left middle cerebral artery territory shows diffusion-perfusion mismatch.

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  Fig. 2 Angiographic findings of cerebral flow. (A) Magnetic resonance angiography shows stopping of left middle cerebral artery (arrow). (B) Left internal cerebral artery angiography reveals abrupt cessation of left proximal middle cerebral flow (arrow).

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  Fig. 3 Left internal cerebral artery angiography shows recanalization of middle cerebral artery after mechanical intra-arterial embolectomy.

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  Fig. 4 Retrievable solitaire stent and captured emboli are shown (arrows).

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