Endovascular treatment for intracranial infectious aneurysms

Wajnberg, Eduardo; Rueda, Fernanda; Marchiori, Edson; Gasparetto, Emerson L.

doi:10.1590/s0004-282x2008000600002

Cited by 19 publications

(17 citation statements)

References 13 publications

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“…After screening of the titles and abstracts, 63 studies were selected for full review [1,3,4,7,10,11,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71]. Thirty studies with 2 or more patients and 33 case reports with a total number of 814 patients were identified.…”

Section: Resultsmentioning

confidence: 99%

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Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Hamisch¹,

Mpotsaris

Timmer³

et al. 2016

Cerebrovasc Dis

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Objective: Intracranial infectious aneurysms (IIAs) are a rare clinical entity without a definitive treatment guideline. In this study, we evaluate the treatment options of these lesions based on our own clinical experience and review the current knowledge of therapy as portrayed in the literature. Methods: We conducted a single-center retrospective analysis of all patients with an IIA and performed a systematic review of the literature using the MEDLINE database. We undertook a comprehensive literature search using the OVID gateway of the MEDLINE database (1950-October 2015) using the following keywords (in combination): ‘infectious', ‘mycotic', ‘cerebral aneurysm', ‘intracranial aneurysm'. 1,721 potentially relevant abstracts were identified and 63 studies were selected for full review. The studies were analysed regarding ruptured versus unruptured aneurysms, aneurysm localization and treatment, as well as clinical and radiological outcome. Results: Our institutional series consisted of 6 patients (median age 57 [32-76]) treated between 2011 and 2015. All patients presented with ruptured IIAs located on the middle cerebral artery (MCA, 5 patients) and anterior cerebral artery (ACA, 1 patient). Five patients were treated by clipping and resecting the aneurysm, 1 patient underwent coiling. All patients received antibiotic therapy and 1 patient died. We further identified 814 patients (median age 35.5 [0-81]) in 63 studies. Locations of the aneurysms were mentioned in 55 studies. The most frequent locations of the aneurysms were: MCA (63.5%), posterior cerebral artery (14%), ACA (9.0%) and others (13.5%). Treatment for IIAs was described in 62 studies: antibiotic treatment (56.1%), a combination of antibiotics and surgery (20.9%) or antibiotics and endovascular treatment (23.0%). Outcome was mentioned in 82.4% of the patients with a mortality rate of 16.8%. An evaluation of treatment outcome was limited due to the heterogeneity of patients in the published case series. Conclusion: Antibiotic therapy of patients with IIA is mandatory. However, due to the complexity of the disease and its accompanying comorbidities, a general treatment algorithm could not be defined. Analogous to non-mycotic aneurysms, further treatment decisions require an interdisciplinary approach involving neurosurgeons, interventionists and infectious disease specialists.

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Section: Resultsmentioning

confidence: 99%

“…The reported mortality rate varies from 30 to 80% [1,3,17,18] and depends on different factors, including rupture and predisposing factors.…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Hamisch¹,

Mpotsaris

Timmer³

et al. 2016

Cerebrovasc Dis

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“…Several cases initially addressed the use of endovascular intervention to treat mycotic aneurysms resulting from infective endocarditis, 4,11,12,18,23 but only a few cases have been reported using interventional endovascular methods in infective endocarditis-associated ischemic strokes, including catheter-guided intraarterial tPA. 2,21 In this article we present a potential option in the treatment of infective endocarditis-associated acute ischemic stroke: the successful use of an endovascular method in a case in which thrombolytic therapy was not an option.…”

Section: Discussionmentioning

confidence: 99%

Endovascular intervention for acute stroke due to infective endocarditis

Dababneh

Hedna

Ford

et al. 2012

FOC

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The overall incidence of neurological complications due to infective endocarditis is as high as 40%, with embolic infarcts more common than hemorrhagic strokes. The standard of care for typical strokes does not apply to infective endocarditis because there is a substantial risk of hemorrhage with thrombolysis. In the last decade there have been multiple case reports of intravenous and intraarterial thrombolysis with successful outcomes for acute strokes with related infective endocarditis, but successful endovascular interventions for acute strokes associated with infective endocarditis are rarely reported. To the authors' knowledge, this report is the first case in the literature to use a mechanical retrieval device in successful vegetation retrieval in an infective endocarditis acute stroke. Although an interventional approach for treatment of acute stroke related to infective endocarditis is a promising option, it is controversial and a cautious clinical decision should be made on a case-by-case basis. The authors conclude that this approach can be tested in a case series with matched controls, because this condition is rare and a randomized clinical trial is not a realistic option.

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“…[36141720] They can present as either a single isolated lesion or can be multiple and when ruptured, the erosive arteritis normally presents with an intracranial hemorrhage, with or without subarachnoid extension. [811121420] Although fungal aneurysms tend to occur more proximally involving the larger basal arteries, bacterial lesions are more commonly located along the distal MCA branches. [5919] In cases of endocarditis, when an unruptured mycotic aneurysm is identified the combined mortality rate approximates 30%, but this number increases to 50% if the aneurysm ruptures.…”

Section: Discussionmentioning

confidence: 99%

“…[111216] These lesions most commonly affect the distal middle cerebral artery (MCA) branches and represent a management challenge. [141620] When surgical treatment is required, these lesions can be difficult to locate deep within the sylvian fissure, and may defy primary reconstruction because of their friable nature. In some cases, vascular sacrifice may be utilized, but this option risks ischemic injury to the brain irrigated by the involved arterial segment.…”

Section: Introductionmentioning

confidence: 99%

A short segment intracranial-intracranial jump graft bypass followed by proximal arterial occlusion for a distal MCA aneurysm

Nussbaum

Defillo²,

Zelensky³

et al. 2011

Surg Neurol Int

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Background:To describe the use of a short segment cortical intracranial–intracranial (IC–IC) bypass for the treatment of a distal middle cerebral artery (MCA) aneurysm.Case Description:A 54-year-old woman presented with a loss of consciousness followed by multiple seizures and was found to have a partially thrombosed distal MCA aneurysm. This possibly mycotic aneurysm was treated by creating a short segment jump graft between a normal cortical artery and a nearby cortical branch arising from the aneurysmal M3 arterial segment. The bypass allowed for subsequent occlusion of the aneurysmal vessel without ischemic consequence. At surgery, the anterior division of the superficial temporal artery (STA) was exposed and dissected. Intraoperative angiography was utilized to localize a cortical artery arising from the involved segment as well as a nearby cortical artery arising from a distinct, uninvolved MCA branch. A segment of the STA was harvested, and then 10-0 suture was utilized to anastomose this short segment, to both the involved and normal cortical arteries. This created a short jump graft allowing for subsequent sacrifice of the diseased artery. Following surgery, the patient immediately underwent coil embolization of the aneurysm back into the parent artery resulting in local vascular sacrifice. The remainder of the patient's hospital course was uneventful. She was discharged home in good condition.Conclusions:We suggest that cortical IC–IC bypass followed by endovascular arterial sacrifice as performed in our case represents a simple and safe option for treating unclippable distal MCA aneurysms including mycotic lesions.

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Endovascular treatment for intracranial infectious aneurysms

Cited by 19 publications

References 13 publications

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Endovascular intervention for acute stroke due to infective endocarditis

A short segment intracranial-intracranial jump graft bypass followed by proximal arterial occlusion for a distal MCA aneurysm

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