Infective endocarditis with rupture of a dissecting aneurysm two days after thrombectomy

Abstract

We report the case of a 70-year-old man who was transferred to our department by an ambulance with the chief complaint of disturbed consciousness. Brain magnetic resonance imaging revealed the occlusion of the left horizontal anterior cerebral artery (A1) to the bilateral vertical anterior cerebral artery (A2) as well as acute cerebral infarction in the bilateral anterior cerebral artery region. We performed mechanical thrombectomy therapy and recanalized the right A2 site, although we could not perform the same procedure at the left A2 site. We observed no intracranial hemorrhage during or immediately after the operation. However, 2 days after the operation, subarachnoid hemorrhage, hydrocephalus, and a pseudoaneurysm appeared in the anterior communicating artery. Accordingly, we performed ventricular drainage and maternal vessel occlusion of the left A1. Echocardiography detected a wart on the aortic valve, and blood culture revealed the presence of Enterococcus faecalis, leading to the diagnosis of infective endocarditis. The patient received antibiotic treatment with ceftriaxone, vancomycin, and piperacin; consequently, the symptoms of infection improved. However, he then suffered from sudden cardiac arrest and died. Thrombectomy is challenging in embolisms caused by infections such as infective endocarditis, and arterial rupture might occur at a later stage; thus, caution should be exercised.