Efficacy and Safety of Mechanical Thrombectomy in Acute Ischemic Stroke Secondary to Infective Endocarditis: A Systematic Review and Meta-Analysis.

Abstract

Acute ischemic stroke caused by infective endocarditis (IE) represents a critical and complex clinical scenario, often resulting from septic emboli leading to large vessel occlusion. While mechanical thrombectomy (MT) has become standard therapy for acute ischemic stroke in the general population, its role in the context of IE remains controversial due to heightened concerns regarding hemorrhagic transformation and procedural safety. To better understand the outcomes of MT in this high-risk population, we conducted a systematic review and meta-analysis comparing MT in patients with IE-related stroke to those with non-IE stroke etiologies. Three studies comprising a total of 132 patients with IE-related stroke and 381 patients with non-IE stroke were analyzed. Our results demonstrate that patients with IE-related stroke undergoing MT had significantly lower odds of successful recanalization and favorable functional outcomes, and a markedly higher risk of all-cause mortality. Specifically, successful recanalization was achieved less frequently [odds ratio (OR), 0.50; 95% confidence interval (CI), 0.29-0.84], and the rate of favorable outcomes (modified Rankin Scale 0-2) was lower (risk ratio, 0.63; 95% CI, 0.40-0.99). Mortality was significantly increased in the IE group (OR, 2.09; 95% CI, 1.11-3.92). These findings suggest that while MT may still offer a potential benefit in select cases, its overall outcomes in IE-related stroke are less favorable compared with other stroke etiologies. Caution is warranted when considering MT in this setting, and further prospective studies are needed to guide clinical decision-making.