Timing surgery and hemorrhagic complications in endocarditis with concomitant cerebral complications.
Clin Neurol Neurosurg
; 214: 107171, 2022 03.
Article
em En
| MEDLINE
| ID: mdl-35180644
ABSTRACT
BACKGROUND:
To date, limited studies have been conducted regarding the safe timing of valvular repair for infectious endocarditis (IE) in patients with radiographic findings consistent with embolic stroke or infectious intracranial aneurysm (IIA).METHODS:
A single-center, retrospective review of valvular surgeries for IE was performed (2011-2019). Outcomes for patients who underwent cranial image screening and those who did not were subsequently compared.RESULTS:
276 patients underwent valvular repair for IE; 186 (67.4%) were male. The mean age was 51.0 (17.4) years. Mean time from imaging to surgery was 7.5 days. 124 (44.9%) underwent baseline cranial imaging. Of these, 22 (17.7%) had findings concerning for ischemic stroke from embolic origin. 65 patients underwent baseline diagnostic cerebral angiography. 10 (15%) of these patients harbored an IIA. Four out of these 10 (40%) underwent intervention for an IIA. Two of the four who underwent intervention (50.0%) had ruptured IIAs. The remaining six (60%) patients with IIAs received treatment with antibiotics alone. None of the patients with IIAs suffered from symptomatic hemorrhage after valvular surgery. No significant difference in symptomatic hemorrhage after valvular surgery between those with ischemic embolic stroke compared to those without (ischemic stroke-4.5% vs. no ischemic stroke-1.0%; p = 0.32).CONCLUSIONS:
Patients with radiographic evidence of ischemic stroke from septic emboli can safely undergo valvular surgery for IE without increased risk of symptomatic hemorrhage. We advocate for baseline CTA screening to evaluate for IIA in patients who present with a primary diagnosis of IE and propose a management algorithm.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Aneurisma Infectado
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Embolia
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Endocardite
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AVC Embólico
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Humans
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Male
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Middle aged
Idioma:
En
Revista:
Clin Neurol Neurosurg
Ano de publicação:
2022
Tipo de documento:
Article