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Ischemic stroke
Original research
Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis
  1. Huanwen Chen1,2,
  2. Marco Colasurdo3,
  3. Mihir Khunte4,
  4. Ajay Malhotra4,
  5. Dheeraj Gandhi5
    1. 1National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
    2. 2Neurology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
    3. 3Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
    4. 4Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
    5. 5Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
    1. Correspondence to Dr Dheeraj Gandhi; dgandhi{at}umm.edu

    Abstract

    Background The safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear.

    Methods In this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT versus medical management (MM) for patients with LVO and IE. Primary outcome was routine home discharge with self-care. Secondary outcomes include home discharge, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses.

    Results 2574 patients were identified; 656 (25.5%) received EVT. After PSM, the rate of routine discharge was significantly higher for patients with EVT compared with MM (14.6% vs 8.5%, p=0.021), and patients with EVT had significantly higher rate of home discharge (34.5% vs 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs 25.2%, p=0.002), and lower rate of ICH (15.8% vs 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared with MM (11.2% vs 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments.

    Conclusion For patients with LVO stroke and IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared with MM.

    • Stroke
    • Infection
    • Thrombectomy
    • Thrombolysis
    • Hemorrhage

    Data availability statement

    Data may be obtained from a third party and are not publicly available. Restrictions apply to the availability of these data. Data were obtained from the Healthcare Cost and Utilization Project (HCUP) and are available for purchase at https://hcup-us.ahrq.gov with the permission of HCUP.

    https://doi.org/10.1136/jnis-2024-022374

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      Data availability statement

      Data may be obtained from a third party and are not publicly available. Restrictions apply to the availability of these data. Data were obtained from the Healthcare Cost and Utilization Project (HCUP) and are available for purchase at https://hcup-us.ahrq.gov with the permission of HCUP.

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      Footnotes

      • X @AjayMalhotraRad

      • HC and MC contributed equally.

      • Contributors HC, MC, and DG conceived the study idea. HC and MK developed the analysis methods. HC performed the analysis and visualized the data. HC and MC interpreted the results and wrote the manuscript. AM and DG revised the manuscript. All authors approve the final manuscript. DG is the guarantor of the study.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; internally 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.