Abstract Body: Background: The safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared to medical management (MM) is unclear.

Methods: In this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT vs. medical management (MM) for LVO patients with IE. Primary outcome was routine discharge to home with self-care. Secondary outcomes include discharge to home, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses.

Results: 2,574 patients were identified; 656 (25.5%) received EVT. After PSM, EVT was associated with more favorable hospitalization outcomes (Figure 1). The rate of routine discharge was significantly higher for EVT patients compared to MM (14.6% vs. 8.5%, p=0.021), and EVT patients had significantly higher rate of home discharge (34.5% vs. 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs. 25.2%, p=0.002), and lower rate of ICH (15.8% vs. 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared to MM (11.2% vs. 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments.

Conclusion: For LVO stroke patients with IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared to MM.