{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T22:58:16Z","timestamp":1780095496555,"version":"3.54.0"},"reference-count":25,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Infective endocarditis (IE) could cause cerebral infarction through septic embolization, presenting challenges in both diagnosis and treatment. Because intravenous thrombolysis is contraindicated in suspected IE-related stroke, careful evaluation of cerebral perfusion and infarct extent is crucial for selecting appropriate therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Case Description:<\/jats:title>\n                    <jats:p>\n                      A 45-year-old woman was admitted to the emergency department with fever and disturbance of consciousness. Imaging revealed a cerebral infarction due to right internal carotid artery (ICA) occlusion. Echocardiography demonstrated a vegetation on the mitral valve, suggesting IE as the embolic source. As the onset time was unclear and no diffusion-weighted image-fluid-attenuated inversion recovery mismatch was observed, intravenous alteplase was considered inappropriate. Although the neurological deficit was mild, computed tomography perfusion (CTP) imaging showed extensive hypoperfusion in the right ICA-middle cerebral artery territory with a limited infarct core. Mechanical thrombectomy was therefore performed. The procedure was technically challenging, requiring a switch from aspiration thrombectomy to a combined stent retriever technique, ultimately achieving successful recanalization (thrombolysis in cerebral infarction grade 2b). Histopathological examination of the retrieved thrombus revealed fibrin-rich material containing bacterial colonies, and blood cultures were positive for\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      . Subsequently, the mitral vegetation enlarged, necessitating urgent mitral valve replacement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case illustrates the usefulness of CTP imaging in guiding treatment decisions for low National Institutes of Health Stroke Scale large-vessel occlusion associated with IE. It also emphasizes that histopathological examination of retrieved thrombi could provide valuable insights into the underlying infectious etiology and inform subsequent management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/sni_1138_2025","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T08:21:35Z","timestamp":1769761295000},"page":"48","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Computed tomography perfusion-guided mechanical thrombectomy and histopathological analysis of a fibrin-rich septic embolus in infective endocarditis-related internal carotid artery occlusion"],"prefix":"10.25259","volume":"17","author":[{"given":"Masahiro","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Yamagata City Hospital Saiseikan, Yamagata, 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