Abstract Background and aims To analyze the clinical, microbiological, and therapeutic characteristics of patients with infective endocarditis (IE) who developed stroke during the course of the disease. Methods We conducted a retrospective descriptive study at a tertiary referral center. Between 2013 and 2025, 35 patients with IE experienced an acute stroke. Demographic data, neurological presentation, affected valve, isolated microorganism, treatments, complications, and survival were analyzed. Results Thirty-five patients were included (65.7% male; mean age 68.4 ± 12.4 years). In 14 cases (40%), stroke was the initial manifestation of IE. Ischemic stroke was the most frequent presentation (71.4%), followed by subarachnoid hemorrhage (11.4%). Enterococcus spp. was the most frequently identified pathogen (17.1%), followed by Staphylococcus aureus (14.3%). The aortic valve was most commonly affected (48.6%), with a predominance of native valve involvement (51.4%). Acute reperfusion therapy was administered in four patients (two intravenous thrombolysis, one mechanical thrombectomy, and one combined therapy), resulting in clinical improvement in two patients and hemorrhagic transformation in the remaining two. After stroke, 12 patients (34.2%) underwent cardiac surgery, with a mean interval of 13.58 days. One-year mortality was 34.3%. Conclusions Ischemic stroke, the most frequent neurological manifestation of IE, represents a major therapeutic challenge, as thrombolysis carries a significant hemorrhagic risk and the underlying endocarditis may be unrecognized in the acute phase. In our series, a significant proportion of patients underwent early cardiac surgery within the first 15 days after the stroke, despite ongoing controversy regarding the optimal timing of surgery. Conflict of interest IRENE BELMONTE HURTADO: NOTHING TO DISCLOSE
Monedero et al. (Fri,) studied this question.