Background and Objectives Infective endocarditis (IE) is frequently complicated by neurologic events, most commonly acute ischemic stroke (AIS) from septic emboli. Intravenous thrombolysis (IVT) has traditionally been contraindicated due to hemorrhagic risk, although inflammatory vascular injury in IE suggests multifactorial mechanisms of stroke beyond septic embolism alone. Little is known regarding the impact of endovascular therapy (EVT) for AIS due to IE. We sought to examine nationwide outcomes of patients with IE and AIS to characterize clinical features, outcomes, and risks associated with thrombolysis and endovascular therapy. Methods A retrospective cross‐sectional study was conducted using data from the National Inpatient Sample database between October 1st, 2015 and December 31st, 2022. This nationally representative sample included patients in the United States hospitalized with AIS, reported NIH Stroke Scale score, and reported IE. Propensity score‐based inverse probability of treatment weighting (IPTW) adjusted for confounding factors, including stroke severity. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for all outcomes. Results Among 1,733,390 AIS hospitalizations, 4,085 (0.2%) were subsequently diagnosed with IE. Following IPTW, IE‐AIS demonstrated higher odds of inpatient mortality (aOR: 2.54 1.95‐3.30, p 5, EVT was associated with decreased mortality (0.739 0.558‐0.978, p=0.034), increased routine discharge (2.18 1.46‐3.24, p<0.001), and increased hemorrhagic transformation (1.96 1.54‐2.49, p<0.001). Discussion Our findings support growing evidence that EVT may offer benefit in this high‐risk group, even if outcomes remain worse than in AIS from non‐IE causes. While prior studies have compared EVT safety in IE‐AIS against various control populations, our nationwide analysis demonstrates that EVT remains favorable relative to no intervention. Overall, IE‐AIS confers significantly greater inpatient mortality and lower functional recovery compared to other AIS etiologies, underscoring the need for heightened clinical vigilance and individualized management. Future prospective work is required to clarify optimal treatment strategies and further define the role of EVT in this challenging population.
Sinton et al. (Sat,) studied this question.