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Published on: September 25, 2009
Mycotic internal carotid artery aneurysm: A literature review inspired by a case
Madeleine de Boer1, Connor Greatbatch1, David Cottier1
1Department of Vascular Surgery, Royal Hobart Hospital, Hobart, TAS, Australia.
Abstract:
BackgroundMycotic aneurysms of the extracranial carotid artery are a rare consequence of localised or systemic infection. Typically caused by Staphylococcal infections, sequelae include further bacterial dissemination, stroke, rupture and death. Scarcely discussed in literature, the management of this pathology is limited to case reports and general consensus.MethodThe case of an internal carotid artery mycotic aneurysm in the setting of contralateral internal carotid artery occlusion managed with urgent endovascular repair is discussed. A systematic review was subsequently conducted according to PRISMA guidelines to further review the preferred management for this uncommon pathology.ResultA total of 38 articles discussing the clinical details of 48 mycotic ICA aneurysms in the adult population were reviewed. Similarly to the described case, the majority of infections were due to Staphylococcus species; however, contrary to the present case, most were managed with open repair. All cases were managed with antibiotic therapy.ConclusionWhilst most cases previously described in the literature have been managed with open bypass grafting, the present case describes an alternative treatment method with endovascular management in the emergent setting with good outcomes at 1-year post-stent placement.
Insights
Mycotic aneurysms of the extracranial carotid artery, often caused by Staphylococcus, are rare but serious. This study presents an endovascular repair case and review, suggesting it as a viable alternative to open repair for these challenging infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Interventional Radiology
Background:
- Mycotic aneurysms of the extracranial carotid artery are rare, often stemming from Staphylococcus infections.
- Potential complications include stroke, rupture, and death, with limited established management guidelines.
Purpose of the Study:
- To discuss the management of internal carotid artery mycotic aneurysms.
- To present a case of urgent endovascular repair for a mycotic aneurysm.
- To conduct a systematic review on preferred management strategies.
Main Methods:
- A case report of endovascular repair for a mycotic internal carotid artery aneurysm.
- A systematic literature review following PRISMA guidelines.
- Analysis of 48 cases of mycotic internal carotid artery aneurysms from 38 articles.
Main Results:
- Staphylococcus species were the most common cause of infection, consistent with the case report.
- While most reviewed cases favored open repair, the presented case utilized endovascular repair.
- All patients received antibiotic therapy, and the endovascular approach showed good 1-year outcomes.
Conclusions:
- Endovascular management offers an alternative to open bypass grafting for mycotic internal carotid artery aneurysms, particularly in emergent situations.
- This approach demonstrated favorable outcomes at one year post-intervention.
- Further research into endovascular techniques for mycotic aneurysms is warranted.
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