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Endovascular treatment of bacterial intracranial aneurysms
Insights
Endovascular treatment effectively occluded bacterial intracranial aneurysms in three patients. This approach offers a rapid and safe alternative for selected severe cases of these challenging brain aneurysms.
Area of Science:
- Neurology
- Interventional Radiology
Background:
- Bacterial intracranial aneurysms are rare but serious cerebrovascular conditions.
- Treatment options for these aneurysms, especially those in deep or distal locations, can be challenging.
Observation:
- Three patients with bacterial intracranial aneurysms were treated using an endovascular approach.
- Two patients presented with severe neurological deficits secondary to endocarditis, while one had suspected vasculitis.
- Imaging revealed intracerebral hematomas and, in one case, bacterial aneurysms of distal middle cerebral artery branches.
Findings:
- Endovascular treatment involved hyperselective catheterization and glue injection to occlude the aneurysm and parent vessel.
- Follow-up angiography confirmed successful aneurysm occlusion in all treated patients.
- Outcomes varied: one patient recovered fully, another had residual deficits from the hematoma, and one died due to a new aneurysm rupture.
Implications:
- Endovascular occlusion of bacterial intracranial aneurysms and parent vessels is a viable alternative to surgery in select severe cases.
- This technique may be particularly beneficial for deep or distal aneurysms where surgical access is difficult.
- Careful patient selection and monitoring are crucial due to the potential for new aneurysm formation or rupture.
Abstract:
We report three patients with bacterial intracranial aneurysms treated by the endovascular approach: two presented with sudden severe neurological deficits after a diagnosis of endocarditis; the other had suspected vasculitis. CT showed an intracerebral haematoma in all cases; angiography revealed bacterial aneurysms of distal branches of the middle cerebral artery in one. Because of the patients' condition and the location of the aneurysms, endovascular treatment was considered the fastest and safest treatment. Hyperselective catheterisation of the parent branch, close to the aneurysm, was performed with a microcatheter. A small amount of glue was injected to occlude both the aneurysm and a short segment of the diseased vessel. Follow-up angiography revealed occlusion of the aneurysm in all cases. One patient recovered completely; one recovered over some months, with neurological deficit due to the haematoma. The third patient suddenly worsened and died 9 days after treatment for a contralateral haematoma, due to rupture of a new bacterial aneurysm of the middle cerebral artery. Endovascular occlusion of the aneurysm and parent vessel may be an alternative to surgery in selected, severe cases of deep or distal bacterial intracranial aneurysms.