A vegetation length threshold of 10 mm was iden- tified as having the highest predictive value for embolic events while on adequate antibiotic ther- In a small randomized trial including 76 patients with left-sided IE, severe mitral valve or aortic disease, and large vegetations (>10 mm), early surgery (within 48 hours of randomization) was associated with a significant reduction of the composite end point of in-hospital death or embolic with conventional treatment.464 8. Decisions on the optimal timing of surgical inter- vention in patients with IE after an acute stroke should balance the benefits associated with sur- gical correction of the IE lesion with the risk of worsening of the neurological insult attributable to ICH (typically caused by hemorrhagic conversion of ischemic lesions, mycotic aneurysms, or septic necrotic arteritis), hypotension, and further intraop- In patients with IE who have had an acute stroke without extensive neurologi- cal damage and no intracranial hemorrhage, data suggest that early surgery (with no delay) may be associated with better outcomes.33,466,467 An early Japanese retrospective study including 181 of 244 patients with cerebral complications reported a correlation between the time delay to surgery and More recently, a prospective cohort study evaluated the relationship between the tim- ing of surgery after a stroke and in-hospital and CLINICAL STATEMENTS AND GUIDELINES Kleindorfer A total of 198 patients with IE who underwent valve replacement surgery after a stroke were analyzed. Of these, 58 patients (29.3%) underwent early surgical treatment and 140 (70.7%) had late surgical treatment. After adjustment for other risk factors, early surgery was not associated with increased in-hospital or 1-year 9. 