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Ischemic stroke
Original research
Concurrent bacterial endocarditis is associated with worse inpatient outcomes for large vessel occlusions
  1. Ian A Ramsay1,
  2. Turki Elarjani2,
  3. Vaidya Govindarajan2,
  4. Michael A Silva2,
  5. Ahmed Abdelsalam2,
  6. Joshua D Burks2,
  7. Robert M Starke2,
  8. Evan Luther2
  1. 1 MD-MPH Program, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2 Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Ian A Ramsay, University of Miami Miller School of Medicine, Miami, FL 33136, USA; ian.ramsay{at}med.miami.edu

Abstract

Background Neurological complications of bacterial endocarditis (BE) are common, including acute ischemic stroke (AIS). Although mechanical thrombectomy (MT) is effective for large vessel occlusion (LVO) stroke, data are limited on MT for LVOs in patients with endocarditis. We assess outcomes in patients treated with thrombectomy for LVOs with concurrent BE.

Methods The National Inpatient Sample (NIS) was used. The NIS was queried from October 2015–2019 for patients receiving MT for LVO of the middle cerebral artery. Odds ratios (OR) were calculated using a multivariate logistic regression model.

Results A total of 635 AIS with BE patients and 57 420 AIS only patients were identified undergoing MT. AIS with BE patients had a death rate of 26.8% versus 10.2% in the stroke alone cohort, and were also less likely to have a routine discharge (10.2% vs 20.9%, both P<0.0001). AIS with BE patients had higher odds of death (OR 3.94) and lower odds of routine discharge (OR 0.23). AIS with BE patients also had higher rates of post-treatment cerebral hemorrhage, 39.4% vs 23.7%, with an OR of 2.20 (P<0.0001 for both analyses). These patients also had higher odds of other complications, including hydrocephalus, respiratory failure, acute kidney injury, and sepsis.

Conclusion While MT can be used to treat endocarditis patients with LVOs, these patients have worse outcomes. Additional investigations should be undertaken to better understand their clinical course, and further develop treatments for endocarditis patients with stroke.

  • Stroke
  • Thrombectomy

Data availability statement

Data are available in a public, open access repository. The authors have full access to the data. All data used for this study are from the National Inpatient Sample Database, available from the Healthcare Cost and Utilization Project as part of the Agency for Healthcare Research and Quality, or from the authors on reasonable request.

https://doi.org/10.1136/jnis-2023-020381

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    Data availability statement

    Data are available in a public, open access repository. The authors have full access to the data. All data used for this study are from the National Inpatient Sample Database, available from the Healthcare Cost and Utilization Project as part of the Agency for Healthcare Research and Quality, or from the authors on reasonable request.

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    Footnotes

    • X @AbdelsalamMd, @Starke_neurosurgery

    • Contributors IR: Study design, data analysis, literature review, drafting of manuscript. VG: study design, data analysis. TE, MS, AA, JB: critical review and editing of manuscript. RS: study conception, critical review and editing of manuscript. EL: study conception, study design, literature review, drafting, review, and editing of manuscript. Responsible for overall content as guarantor of study: IR. All authors substantially contributed to the final draft.

    • Funding Robert M Starke’s research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and by the National Institutes of Health (R01NS111119-01A1) and (UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Robert M Starke also has an unrestricted research grant from Medtronic.

    • Competing interests The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Robert M Starke has consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo, and Cerenovus.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.