Role of cerebral CTA screening on treatment planning and outcome in patients with left sided infective endocarditis

Abstract

Large number of infective endocarditis (IE) patients remain clinically silent till hemorrhagic events occur with very poor outcome. The aim of this work was to study the impact of detection of this silent group by cerebral CT angiography (CTA) – which is not a standard practice – on the treatment decisions and outcome in patients with left sided IE. Patients and methodsFrom July 2007 to December 2012, 81 patients with left-sided IE (mean age was 30.43±8.8years. 49 males) had brain CTA within 1week of admission. All patients with ICMA underwent four-vessel angiography. Treatment of intracranial mycotic aneurysms (ICMA) was done either by endovascular or surgery. ResultsBrain CTA revealed 51 patients with cerebral embolization. 26 patients had ICMA, 13 went for endovascular treatment 6 of them were clinically silent. 2 went for open surgery and 11 spontaneously thrombosed on treatment. The findings in brain CTA prompted changes in treatment decisions in 21 patients (25.6%). The mortality in ICMA patients was 19.2% which is significantly lower than most of the published literature. ConclusionRoutine assessment of patients with left sided IE by cerebral CTA can change the treatment plans leading to significant reduction in mortality rate and improved outcome.