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Clinical challenges associated with the endovascular treatment of acute stroke in a patient with infective endocarditis

대한뇌혈관외과학회지 2020년 22권 3호 p.176 ~ 181
Settarzade Emil, Peker Ahmet, Topcuoglu M. Akif, Arsava E. Murat, Demircin Metin, Arat Anil,
소속 상세정보
 ( Settarzade Emil ) - Hacettepe University Faculty of Medicine Department of Radiology
 ( Peker Ahmet ) - Hacettepe University Faculty of Medicine Department of Radiology
 ( Topcuoglu M. Akif ) - Hacettepe University Faculty of Medicine Department of Neurology
 ( Arsava E. Murat ) - Hacettepe University Faculty of Medicine Department of Neurology
 ( Demircin Metin ) - Hacettepe University Faculty of Medicine Department of Cardiovascular Surgery
 ( Arat Anil ) - Hacettepe University Faculty of Medicine Department of Radiology

Abstract


Although stroke is common in infective endocarditis (IE), only 26 cases of thrombectomy have been reported to date for IE-related acute stroke. We report a 40-year-old man who presented with left middle cerebral artery occlusion of unknown cause. Multiple attempts of mechanical aspiration thrombectomy and stentrievers failed to recanalize the artery. Effective revascularization was eventually achieved by placing a self-expanding intracranial stent. Post-procedurally the patient was diagnosed with IE with mitral valve insufficiency, mandating emergent valvular replacement while the patient was still on tirofiban infusion. On follow-up, the patient had a modified Rankin’s score of 0, had no recurrent stroke, and the intracranial stent remained patent yet stenosed. Based on the use of a self-expanding intracranial stent in the setting of IE, we discuss the consequences of the fibrotic and inflammatory content of the embolus and the associated high risk of intracranial hemorrhage which complicates clinical decision making.

키워드

Stroke; Infective endocarditis; Stent

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