Intracranial hemorrhage (ICH) represents a severe complication of infective endocarditis (IE) and stands as a significant contributor to the poor prognosis associated with IE. Current guidelines suggested a delay of 4 weeks for cardiac surgery in patients with ICH, but these recommendations were based on insufficient clinical evidence, and recent studies have yielded different opinions. In this paper, we thoroughly reviewed relevant guidelines and their references in conjunction with 3 typical cases with IE and ICH, discussed the recommendations with controversy, and proposed a process for the management of IE with ICH.
Objective To summarize the clinical characteristics of patients with infectious intracranial aneurysm (IIA) associated with infective endocarditis (IE) and to share diagnostic and treatment experiences. MethodsA retrospective analysis was conducted on the clinical data of 554 patients who underwent cardiac surgery for IE at the Department of Cardiac Surgery of Guangdong Provincial People's Hospital from September 2018 to August 2023, and patients with secondary IIA were selected. Patients were divided into two groups based on the treatment plan for IIA: an anti-infection treatment group and an anti-infection plus endovascular treatment group. Results A total of 31 patients with IE complicated by IIA were included, consisting of 21 males and 10 females, with a median age of 33 (26, 53) years. Fifteen patients had no obvious neurological symptoms before the diagnosis of IIA. Seven patients were treated with only anti-infection treatment for IIA; 24 patients underwent anti-infection plus endovascular embolization treatment, with 23 achieving technical success. The interval from IIA endovascular embolization to open-heart surgery was 2 (0, 6) days, and 9 patients underwent concurrent combined surgery. In the anti-infection treatment group, 3 patients of IIA rupture and bleeding occurred, and all died on the day of spontaneous discharge. In the anti-infection plus endovascular treatment group, 1 patient experienced aneurysm rupture leading to death. The remaining patients recovered well postoperatively, with no new neurological symptoms. Conclusion IE patients should pay attention to head imaging examination to screen for IIA. In addition to regular anti infection measures, intracavitary therapy can be considered as a reasonable treatment plan for IIA in IE patients with indications for cardiac surgery.