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Selective endovascular techniques in the treatment of cerebral mycotic aneurysms. Report of three cases
M H Khayata1, A Aymard, A Casasco
1Department of Interventional Neuroangiography, Lariboisière Hospital, Paris University, France.
Abstract:
The aim of this study was to evaluate the role of endovascular treatment for intracranial mycotic aneurysms. The clinical and angiographic features of three patients with endocarditic vegetation (two with Streptococcus viridans and one with Staphylococcus) were reviewed retrospectively. Patients were selected for this treatment according to the clinical setting and aneurysm location. In two cases, selective catheterization of a distal middle cerebral and posterior cerebral artery branch with a microcatheter followed by superselective amobarbital testing of the parent vessel was preliminary to the occlusion of that vessel with autologous clot or glue. The third patient was treated by selective occlusion of the aneurysm by intra-aneurysmal placement of platinum minicoils. Two patients presented with intracranial hemorrhage and in one the lesion was found on computerized tomography. All three aneurysms had been excluded from the circulation at the 6-month follow-up review. The only complication from the procedure, despite the septic nature and distal localization, was balloon deflation in one patient, who was successfully retreated with coils. Endovascular embolization is indicated in patients who are at risk of hemorrhage and cannot undergo the standard procedure. The superselective amobarbital test allows selection of patients who will tolerate distal vessel occlusion. This endovascular procedure represents a safe and effective treatment for these lesions.
Insights
Endovascular embolization offers a safe and effective treatment for intracranial mycotic aneurysms, particularly for patients at risk of hemorrhage. This minimally invasive approach successfully excluded aneurysms in all treated patients.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Intracranial mycotic aneurysms are rare but serious complications of endocarditis.
- Traditional surgical treatment carries significant risks, especially for distal lesions.
Observation:
- Retrospective review of three patients with endocarditic vegetation (Streptococcus viridans, Staphylococcus).
- Patients presented with intracranial hemorrhage or incidental findings on CT.
- Aneurysms were located in distal middle cerebral and posterior cerebral artery branches.
Findings:
- Endovascular treatment, including microcatheter-guided occlusion with clot/glue and intra-aneurysmal coiling, was successfully performed.
- Superselective amobarbital testing aided in patient selection for distal vessel occlusion.
- All treated aneurysms were excluded from circulation at 6-month follow-up with minimal complications.
Implications:
- Endovascular embolization is a viable alternative for patients unsuitable for standard surgery.
- The superselective amobarbital test is crucial for predicting tolerance to distal vessel occlusion.
- This minimally invasive technique demonstrates safety and efficacy in managing complex intracranial mycotic aneurysms.