Neurointervention.  2014 Sep;9(2):101-105. 10.5469/neuroint.2014.9.2.101.

Forced Arterial Suction Thrombectomy of Septic Embolic Middle Cerebral Artery Occlusion Due to Infective Endocarditis: an Illustrative Case and Review of the Literature

• Kim JM
• Jeon JS
• Kim YW
• Kang DH
• Hwang YH
• Kim YS

• KMID: 1910766
• DOI: http://doi.org/10.5469/neuroint.2014.9.2.101

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.

Keyword

Mechanical thrombectomy; Thrombolysis; Infective endocarditis; Acute ischemic stroke

MeSH Terms

Adult
Endocarditis*
Female
Gram-Positive Cocci
Humans
Infarction, Middle Cerebral Artery*
Stroke
Suction*
Thrombectomy*

Figure

• 

  Fig. 1 Summary of brain images and angiographic findings in a 40-year-old woman. A-C. Initial magnetic resonance image and angiography showed acute ischemic change in the left peri-insula area, delayed mean transition time of the left MCA partial territory and a left MCA M1 occlusion. D. The initial gradient-echo image showed a susceptibility vessel sign (arrowhead) in the left MCA. E, F. Cerebral angiography showed a left MCA occlusion at pre-treatment and complete recanalization at post-treatment. G. A gross image of retrieved multiple clots ranging from 3 to 7 mm. H. Microscopic image with hematoxylin and eosin staining, where original magnification ×40 and ×400 of thrombus pathology showed gram positive cocci (thin arrow) and inflammatory cells with fibrin deposition (thick arrow). I-L. In one day follow-up images, we found minimal extension of infarct volume with putamen, normalization of perfusion deficits, complete recanalization of the occluded artery and no susceptibility vessel sign.

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