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Endovascular treatment of mycotic aneurysms: An update meta-analysis
Sávio Batista1, Leonardo de Barros Oliveira2, José Alberto Almeida Filho3
1Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Introduction:
Intracranial mycotic or infectious aneurysms result from the infection of arterial walls, most caused by bacterial or fungal organisms. These infections can weaken the arterial wall, leading to the formation of an aneurysm, a localized dilation, or a bulge. The management can be conservative mainly based on antibiotics or invasive methods such as clipping or endovascular treatment.
Purpose:
We performed a systematic review and meta-analysis of the current literature on endovascular treatment of mycotic aneurysms, analyzing the safety and efficacy associated with this procedure.
Methods:
We systematically searched on PUBMED, Cochrane Library, Embase, and Web of Science databases. Our search strategy was carefully crafted to conduct a thorough investigation of the topic, utilizing a comprehensive combination of relevant keywords. This meta-analysis included all studies that reported endovascular treatment of mycotic aneurysms. To minimize the risk of bias, studies with fewer than four patients, studies where the main outcome was not found, and studies with no clear differentiation between microsurgical and endovascular treatment were excluded.
Results:
In a comprehensive analysis of 134 patients, it was observed that all except one patient received antibiotics as part of their treatment. Among the patients, 56% (a total of 51 out of 90 patients) underwent cardiac surgery. Additionally, three patients required a craniotomy following endovascular treatment. 12 patients experienced morbidity related to the procedures performed, indicating complications arising from the interventions. Furthermore, four aneurysms experienced rebleeding while treatment. A pooled analysis of the endovascular treatment of the mycotic aneurysm revealed a good level of technical success, achieving a 100% success rate in 12 out of 14 studies (97-100%; CI 95%; I2 = 0%), as illustrated in Fig. 2. Similarly, the aneurysm occlusion rate demonstrated a notable efficacy, with a success rate of 97% observed in 12 out of 14 studies (97-100%; CI 95%; I2 = 0%), as depicted in Fig. 3.
Conclusion:
The results strongly support the efficacy of endovascular treatment in achieving technical success, complete aneurysm occlusion, and favorable neurological outcomes. Additionally, the notably low incidence of complications and procedure-related mortality reaffirms the safety and benefits associated with this intervention.
Insights
Endovascular treatment for intracranial mycotic aneurysms shows high technical success and aneurysm occlusion rates. This minimally invasive approach offers a safe and effective option for managing these complex infections.
Area of Science:
- Neurology
- Vascular Surgery
- Infectious Diseases
Background:
- Intracranial mycotic aneurysms arise from arterial wall infections, often bacterial or fungal.
- These infections can lead to arterial weakening and aneurysm formation, posing significant risks.
- Management options include conservative antibiotic therapy and invasive procedures like clipping or endovascular treatment.
Conclusions:
- Endovascular treatment demonstrates strong efficacy in achieving technical success and complete aneurysm occlusion.
- The procedure is associated with favorable neurological outcomes and a low rate of complications and mortality.
- These findings support endovascular intervention as a safe and beneficial option for mycotic aneurysms.
