2026 American Academy of Neurology Abstract Website

Austin Li¹, Aryan Malhotra¹, Shoaib Syed¹, Eric Sinton¹, Christina Armoyan¹, Aarti Jain¹, Nimrod Gozum¹, Jude Al-Mufti¹, Jana Al-Mufti¹, Adam Karp², Uchenna Okafo³, Chaitanya Medicherla², Jon Rosenberg², Andrew Bauerschmidt², Gurmeen Kaur², Ji Chong², Stephan Mayer², Shadi Yaghi⁴, Chirag Gandhi³, Fawaz Al-Mufti²
¹School of Medicine, New York Medical College, ²Neurology, ³Neurosurgery, Westchester Medical Center, ⁴Neurology, Hackensack Meridian Health

Objective:

We sought to examine nationwide outcomes of patients with infective endocarditis (IE) and acute ischemic stroke (AIS) to characterize clinical features, outcomes, and risks associated with intravenous thrombolysis (IVT) and endovascular therapy (EVT).

Background:

IE is frequently complicated by neurologic events, most commonly AIS from septic emboli. 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 EVT for AIS due to IE.

Design/Methods:

A retrospective cross-sectional study was conducted using data from the National Inpatient Sample (NIS) database between 2015 and 2022. Our population included patients in the United States hospitalized with AIS and reported NIH Stroke Scale (NIHSS). 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<0.001) and lower odds of routine discharge (0.263 [0.204-0.340], p<0.001). IE-AIS patients were more likely to receive EVT (1.36 [1.10-1.70], p<0.001) and less likely to receive IVT (0.347 [0.275-0.438], p<0.001). Compared to patients with IE-AIS who did not receive EVT or IVT and had NIHSS > 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).

Conclusions:

Our findings support growing evidence that EVT may offer benefit in IE-AIS patients, even if outcomes remain worse than in AIS from non-IE causes. 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.