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

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.

role of surface ECG and transthoracic echocardiography for predicting postoperative atrial fibrillation after coronary artery bypass surgery

To evaluate the roles of surface electrocardiogram ECG and transthoracic echocardiography ECHO for prediction of atrial fibrillation AF after coronary artery bypass grafting CABG. This study was conducted from 2002-2004 at the Cardiovascular Department of Hacettepe University, Ankara, Turkey. Seventy consecutive patients were enrolled in this study that underwent elective CABG. A 12-lead ECG was recorded one day before cardiac surgery and was repeated during the 5 days after CABG. P-wave dispersion PWD was defined as the difference between maximum and minimum P-wave duration. Differences in P-wave duration were compared between the pre- and postoperative 12-lead ECG measurements. Postoperative AF developed in 17 24% cases of 70 patients. The PWD was found to be significantly higher in patients with AF preoperatively 60 +/- 19 versus 47 +/- 13, p=0.003, postoperative first day 56 +/- 12 versus 44 +/- 11, p<0.002 and fifth day 51 +/- 29 versus 41 +/- 11, p<0.001. Patients with AF were significantly older, the mean age of the AF group was 68 +/- 7 years and of the sinus rhythm SR group was 59 +/- 10 years p<0.001. The AF group had left ventricular systolic dysfunction 56 +/- 13% versus 56 +/- 8%, p=0.042, preoperatively; 49 +/- 8% versus 60 +/- 10%, p=0.001, postoperatively and a larger left atrium 46 +/- 5 versus 39 +/- 5 mm, p<0.001, preoperatively and 44 +/- 7 versus 39 +/- 5 mm, p=0.046, postoperatively than the SR group. This prospective study demonstrated that PWD on surface ECG and additional echocardiographic parameters are simple and reliable indexes to predict the development of AF after CABG