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Endovascular treatment of cerebral mycotic aneurysms
René Chapot1, Emmanuel Houdart, Jean-Pierre Saint-Maurice
1Department of Interventional Neuroradiology, Hôpital Lariboisière, 1 rue Ambroise Paré, 75475 Paris Cedex 10, France. rene.chapot@lrb.ap-hop-paris.fr
Purpose:
To evaluate the endovascular treatment (EVT) of mycotic aneurysms (MAs).
Materials And Methods:
Clinical and radiologic data of 18 MAs treated with EVT were retrospectively reviewed. There were 14 patients (11 men, three women), ranging in age from 28 to 64 (mean age, 44 years). All patients had endocarditis and positive blood culture. The aneurysms were located within the distal cerebral circulation (n = 13) or in the circle of Willis (n = 5). There were 12 ruptured aneurysms and six unruptured aneurysms. Distal or fusiform aneurysms were treated by means of parent vessel occlusion. Proximal saccular aneurysms were selectively treated.
Results:
Endovascular treatment was successful for all aneurysms. No aneurysm bled after embolization during clinical follow-up. Follow-up angiograms obtained in 11 of 14 patients 6 months to 2 years after the procedures showed stable occlusions. Transient complications occurred in two cases, with worsening of hemiparesis and quadrantanopia. Five patients underwent surgical cardiac valve replacement within 1 week of EVT without neurologic complications. The late clinical outcome was normal neurologic status (n = 9) or permanent disability that was related to the initial stroke (n = 5).
Conclusion:
EVT is a reliable and safe technique that should be considered at the time of diagnosis of cerebral mycotic aneurysms.
Insights
Endovascular treatment (EVT) is a safe and effective method for managing mycotic aneurysms (MAs). This study shows EVT success in all cases, offering a reliable option for cerebral mycotic aneurysms.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Mycotic aneurysms (MAs) are rare but serious infections of blood vessels, often occurring in the brain.
- Endovascular treatment (EVT) has emerged as a less invasive alternative to open surgery for various vascular conditions.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular treatment (EVT) for cerebral mycotic aneurysms (MAs).
Main Methods:
- Retrospective review of clinical and radiologic data for 18 MAs in 14 patients treated with EVT.
- Patients presented with endocarditis and positive blood cultures.
- Aneurysms were located in the distal cerebral circulation or circle of Willis, with 12 ruptured and 6 unruptured.
Main Results:
- Successful endovascular treatment (EVT) was achieved in all mycotic aneurysms (MAs).
- No post-embolization bleeding occurred during follow-up; angiograms showed stable occlusions in most patients.
- Transient complications were noted in two patients, with good long-term neurologic outcomes in the majority.
Conclusions:
- Endovascular treatment (EVT) is a reliable and safe therapeutic option for cerebral mycotic aneurysms (MAs).
- EVT should be strongly considered upon diagnosis of mycotic aneurysms.