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Endovascular Treatment of Cerebral Mycotic Aneurysms¹

¹ From the Departments of Interventional Neuroradiology (R.C., E.H., J.P.S.M., A.A., C.M., J.J.M.) and Neurosurgery (G.L.), Hôpital Lariboisière, 1 rue Ambroise Paré, 75475 Paris Cedex 10, France. Received February 8, 2001; revision requested March 26; revision received June 26; accepted July 16. Address correspondence to R.C. (e-mail: rene.chapot@lrb.ap-hop-paris.fr).

PURPOSE: To evaluate the endovascular treatment (EVT) of mycotic aneurysms (MAs).

MATERIALS AND METHODS: Clinical and radiologic data of 18 MAs treated with EVT were retrospectively reviewed. There were 14 patients (11 men, three women), ranging in age from 28 to 64 (mean age, 44 years). All patients had endocarditis and positive blood culture. The aneurysms were located within the distal cerebral circulation (n = 13) or in the circle of Willis (n = 5). There were 12 ruptured aneurysms and six unruptured aneurysms. Distal or fusiform aneurysms were treated by means of parent vessel occlusion. Proximal saccular aneurysms were selectively treated.

RESULTS: Endovascular treatment was successful for all aneurysms. No aneurysm bled after embolization during clinical follow-up. Follow-up angiograms obtained in 11 of 14 patients 6 months to 2 years after the procedures showed stable occlusions. Transient complications occurred in two cases, with worsening of hemiparesis and quadrantanopia. Five patients underwent surgical cardiac valve replacement within 1 week of EVT without neurologic complications. The late clinical outcome was normal neurologic status (n = 9) or permanent disability that was related to the initial stroke (n = 5).

CONCLUSION: EVT is a reliable and safe technique that should be considered at the time of diagnosis of cerebral mycotic aneurysms.

Index terms: Aneurysm, cerebral, 178.733 • Aneurysm, mycotic, 178.733 • Aneurysm, therapy, 178.1264 • Arteries, therapeutic embolization, 178.1264 • Endocarditis, 512.21

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