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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular embolization for intracranial mycotic aneurysms in left ventricular assist device patients: A case
Laura Coyle1, Katelyn Kuper1, Nicole Graney1
1Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, IL.
Background:
An intracranial mycotic aneurysm (MA) is a rare but devasting complication of left ventricular assist device (LVAD) associated endocarditis. Diagnosis and management have been limited to a few case reports. We present a case series reviewing characteristics and outcomes of LVAD patients undergoing endovascular embolization for treatment of a cerebral MA.
Methods:
We retrospectively reviewed all LVAD patients who underwent a diagnostic cerebral angiogram for endovascular treatment of a ruptured MA between April 2022 and October 2025.
Results:
Seven patients, 57% (n = 4) male with a median age 44 ± 18 years, were included. All patients were bacteremic and presented with an intracranial hemorrhage. Diagnostic cerebral angiogram with interventional radiology transcatheter intracranial embolization of the MA with embolic agents n-Butyl Cyanoacrylate (n = 3), Onyx (n = 2), and Hydro Coils (n = 2) successfully occluded all MAs. Five patients (71%) were discharged after 23 ± 9 days, 2 remained hospitalized; 1 expired after 3 days due to withdrawal of care, and the other patient received a heart transplant 64 days after endovascular treatment.
Conclusion:
Patients with LVAD-associated IE are predisposed to neurological complications, and a diagnostic cerebral angiogram should be performed on those who present with an intracranial hemorrhage, as this appears to be predictive of a MA. Endovascular embolization is a promising treatment option for cerebral MAs in considerable risk LVAD patients.
