Endovascular Treatment of Cerebral Mycotic Aneurysms

Abstract

EVT is a reliable and safe technique that should be considered at the time of diagnosis of cerebral mycotic aneurysms.

Endovascular treatment for intracranial infectious aneurysms

“…In this series, 60% of the patients had this treatment modality. In such a procedure, there is a theoretical risk of rupture associated with a rapid burst of increased pressure in the artery stump 6,16 , but we haven't noticed that. In the other two cases (40%), coils were the EvT option.…”

“…The overall mortality rate among these patients is 60%, and increases to 80% in cases associated with subarachnoid hemorrhage (SAh) 2,4,5 . IIAs can be treated with antibiotic therapy alone, with an unpredictable evolution: they can regress, enlarge, stabilize or even rupture 6 . In patients treated with surgery or, more recently, endovascular techniques (EvT), occlusion of the IIAs can be achieved 7,8 .…”

“…The following criteria were used: presence of endocarditis; the aneurysm should be distal, involving segments 2, 3 or 4 of the middle cerebral artery or posterior cerebral artery; or proximal, involving segments M1 and P1 in association with at least two of the following criteria: (a) a change in aneurysm size or morphology on consecutive angiograms (ie, a change in the appearance of the aneurysm or a reduction or increase in its volume on a second angiogram), (b) the presence of another intraor extra-cranial mycotic aneurysm, (c) rupture of the aneurysm, (d) arterial occlusion or stenosis adjacent to the aneurysm, (e) cerebral infarction due to arterial occlusion at the level of the aneurysm and (f) recent neurological focal deficit associated with new aneurysm detection 6 . Since IIA usually forms within 48 hours of embolization (time between the prodroms and the development of the aneurysm), we favored four-vessel cerebral angiography (cAG) in all patients with infective endocarditis who experienced a transient neurological focal deficit during the acute phase of the illness.…”

“…Theoretically, the introduction of foreign material into an infected area could result in prolonged infection and abscess formation 6 . We didn't observe that complication in our five cases, as well as in other reports 6,12 .…”

“…Theoretically, the introduction of foreign material into an infected area could result in prolonged infection and abscess formation 6 . We didn't observe that complication in our five cases, as well as in other reports 6,12 . Besides, septic emboli during effective antimicrobial therapy and/or associated with non-virulent organisms can injure the arterial wall leading to subacute development of aneurysm that are often aseptic at the time of rupture 15 , thus aseptic at the time of the EvT.…”