ArticlePloS one2015
Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 36 citations in OpenAlex.
- Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort.Open forum infectious diseases · 2024Trial
- Cerebral infarction: Surgical timing dilemma inIDCases · 2025Article
- Infective endocarditis presentations during the COVID-19 pandemic: have they paid an untold toll?Global cardiology science & practice · 2024Article
- Hematologic Parameters as Predictors of Long-Term Mortality in Infective Endocarditis Patients.Medical science monitor : international medical journal of experimental and clinical research · 2023Article
- Intravenous Drug Use-Associated Endocarditis Leads to Increased Intracranial Hemorrhage and Neurological Comorbidities.Stroke (Hoboken, N.J.) · 2023Article
- Role of Cerebral Imaging on Diagnosis and Management in Patients With Suspected Infective Endocarditis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- A narrative review of the interpretation of guidelines for the treatment of infective endocarditis.Annals of translational medicine · 2020Review
- Gender differences in clinical features and complications of infective endocarditis: 11-year experience of a single institute in Egypt.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2020Article
- Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as independent predictors of outcome in infective endocarditis (IE).The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2019Article
- Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2019Article
- Extracardiac Imaging of Infective Endocarditis.Current infectious disease reports · 2017Review
- Mycotic Aneurysm Treated with Aneurysm Trapping. Case Report.Journal of neurological surgery reports · 2016Article
- Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis.PloS one · 2016Article
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInfective endocarditis (IE) is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs). These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA) is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE.
methodsFrom July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention.
resultsThe mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%). Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32%) had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%). The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture.
conclusionsRoutine brain CT/CTA resulted in changes in the treatment plan in a significant proportion of patients with IE, even those without clinically evident neurological disease. Routine brain CT/CTA may be indicated in all hospitalized patients with IE.
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