A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion Due to Infective Endocarditis

Treatment modalities are yet to be established for acute ischemic stroke patients with major intracranial vessel occlusion due to infective endocarditis (IE). A 44-year-old man presented with sudden aphasia and right hemiparesis. Magnetic resonance angiography (MRA) showed a left middle cerebral artery occlusion, and a diagnosis of hyperacute ischemic stroke was made. He had fever and high C reactive protein level. Transthoracic echocardiography detected vegetation; therefore, IE was suspected. The patient was treated with intravenous recombinant tissue plasminogen activator, but neurological symptoms worsened. He then underwent mechanical thrombectomy, with subsequent favorable clinical outcome. Pathological examination of the retrieved thrombus revealed a cluster of gram-positive cocci, which were also detected in blood culture. We therefore recommend mechanical thrombectomy as a first-line treatment option in patients with large-vessel occlusions due to IE.