Abstract Number: Esoc2026a1515 Acute Ischemic Stroke in the Setting of Infective Endocarditis: A Retrospective Clinical Overview

Background and aims Infective endocarditis (IE) is an uncommon but important cause of cardioembolic acute ischemic stroke (AIS), associated with diagnostic uncertainty and complex therapeutic decision-making. Stroke occurring in the setting of IE represents a distinct clinical entity with heterogeneous presentation and outcomes. We aimed to provide a descriptive clinical and microbiological overview of AIS associated with infective endocarditis. Methods We conducted a retrospective observational study including 51 consecutive patients with AIS associated with infective endocarditis, admitted to a tertiary stroke center between 2021 and 2025. Microbiological findings, vascular territory involvement, admission to the acute neurological care unit, and functional outcome at discharge assessed by the modified Rankin Scale (mRS) were analyzed descriptively. Results Fifteen patients required care in the acute neurological care unit. Blood cultures were negative in 60.8% of cases. When identified, Staphylococcus species were the most frequently isolated pathogens, followed by Enterococcus faecalis and Escherichia coli. Ischemic strokes predominantly involved the anterior circulation, particularly the middle cerebral artery territory, while posterior circulation infarcts were also observed. In-hospital mortality was 19.6%. Among survivors, 68.6% achieved a favorable functional outcome (mRS 0–2) at discharge. The female-to-male ratio was 16:35, with a mean age of 69 years. Conclusions AIS associated with infective endocarditis remains a severe condition with significant in-hospital mortality. However, favorable functional outcomes were frequently observed among survivors, underscoring the heterogeneous clinical course of this complex stroke subtype and the need for individualized multidisciplinary management. Conflict of interest Vodă, Georgescu, Cireșă, Indrieș, Pleșa, Sîrbu: nothing to disclose