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Mycotic aneurysm detection rates with cerebral angiography in patients with infective endocarditis
Ferdinand K Hui1, Mark Bain1, Nancy A Obuchowski2
1Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Cerebral angiography remains the gold standard for the detection of mycotic aneurysms, and it has been estimated that ruptured mycotic aneurysms result in 5% of the neurological complications of patients with infective endocarditis (IE).
Objective:
To determine the diagnostic yield of cerebral angiography in the above patient population and to assess patient factors that might suggest greater or lesser utility.
Methods:
We retrospectively reviewed 168 patients who underwent cerebral angiography with a diagnosis of IE or infected left ventricular assist device at the Cleveland Clinic between January 2003 and March 2010 in accordance with institutional review board guidelines. Chart and imaging review was performed.
Results:
15/168 patients (8.9%) had mycotic aneurysms; 93.3% (14/15) of the patients with mycotic aneurysms presented with CNS hemorrhage and 66.7% (10/15) had acute ischemic findings. Of the 15 patients with mycotic aneurysms on angiography, seven underwent CT angiography and six underwent MR angiography, which showed mycotic aneurysms in three (42.9%) and two cases (one of which was questionable; 33.3%), respectively.
Conclusions:
Patients with IE or similar sources of central bacterial emboli are prone to neurovascular complications. Approximately 9% of patients with IE at our institution who undergo cerebral angiography have mycotic aneurysms. Presentation with hemorrhage appears to be more predictive of aneurysm, as approximately 22% of patients with IE and hemorrhage were found to have an aneurysm compared with only 1% when hemorrhage was absent. Thus, patients with IE presenting with intracranial hemorrhage should undergo vascular imaging, preferably with cerebral angiography.
Insights
Cerebral angiography detects mycotic aneurysms in about 9% of infective endocarditis patients. Intracranial hemorrhage significantly increases the likelihood of detecting these dangerous neurovascular complications.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Mycotic aneurysms are a serious complication of infective endocarditis (IE).
- Cerebral angiography is the gold standard for diagnosing these aneurysms.
- Ruptured mycotic aneurysms account for 5% of neurological issues in IE patients.
Purpose of the Study:
- To evaluate the diagnostic yield of cerebral angiography for mycotic aneurysms in IE patients.
- To identify patient factors influencing the utility of cerebral angiography.
Main Methods:
- Retrospective review of 168 patients with IE or infected LVADs undergoing cerebral angiography (2003-2010).
- Analysis of patient charts and imaging data.
Main Results:
- Mycotic aneurysms were found in 8.9% (15/168) of patients.
- Most patients with aneurysms presented with CNS hemorrhage (93.3%) or ischemic findings (66.7%).
- CT angiography and MR angiography had lower detection rates compared to cerebral angiography.
Conclusions:
- Patients with IE are susceptible to neurovascular complications like mycotic aneurysms.
- Hemorrhagic presentation is a strong predictor of aneurysms in IE patients (22% vs 1%).
- Vascular imaging, particularly cerebral angiography, is recommended for IE patients with intracranial hemorrhage.
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