Endovascular Therapy for Infectious Intracranial Aneurysm: A Report of Four Cases

Nonaka, Senshu; Oishi, Hidenori; Tsutsumi, Satoshi; Teranishi, Kohsuke; Tanoue, Shunsuke; Yasumoto, Yukimasa; Yamamoto, Munetaka; Arai, Hajime

doi:10.1016/j.jstrokecerebrovasdis.2015.11.033

Cited by 19 publications

(10 citation statements)

References 9 publications

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“…In addition to our own case series, only six studies reported clinical outcomes. [ 6 , 9 , 12 , 14 , 15 ] Favorable outcome was specified for 63.3% of patients ( n = 57). Regarding ruptured IIA, favorable outcome was described in 59.3% ( n = 16).…”

Section: Resultsmentioning

confidence: 99%

“…In general, more recent reports favor endovascular treatment as opposed to open surgery. [ 6 , 9 , 8 , 14 , 15 , 18 ] In part, this is attributable to the fact that to date, there is no evidence of continuing infection due to the presence of coils and stents. [ 5 , 18 ] Neurological deficits after endovascular parent vessel occlusion may be as high as 37.5%.…”

Section: Discussionmentioning

confidence: 99%

“…[ 9 ] As we described in Case 3, early rebleeding can often lead to patients’ poor outcomes and this important issue cannot be ignored. Several reasons favoring endovascular treatment include decreased risk of anesthesia due to shorter anesthetic time,[ 14 , 15 , 17 , 19 ] an option of rapid institution of anticoagulation therapy,[ 17 - 19 ] and reduced treatment delay. [ 17 , 19 ] The latter two factors may be especially important in patients who need urgent cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

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Ruptured intracranial infectious aneurysms: Single Canadian center experience

Son

Mayich

Boulton

et al. 2022

Surgical Neurology International

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Background: Ruptured intracranial infected aneurysms (IIAs) are relatively rare, but they portend high mortality. To the best of our knowledge, there is no Canadian case series on IIA, as well there is a relative paucity of international published experiences. Our purpose is to share the experience of a single Canadian tertiary center in managing ruptured IIA and to conduct a systematic review. Methods: We did a retrospective case review series of adult patients with ruptured IIA treated at our institution. Second, we conducted a systematic review of the literature on ruptured IIA between 2011 and 2021 inclusive. Results: At our institution, of a total eight cases with ruptured IIA, four were treated endovascularly and two by surgical bypass. For the systematic review, we included nine noncomparative studies with a total of 509 patients (318 males) and at least 437 ruptured IIA aneurysms. Favorable outcome was specified for 63.3% of patients (n = 57). Regarding ruptured IIA, favorable clinical outcome was described in 59.3% (n = 16). Conclusion: This study highlights a single Canadian tertiary center experience in the management of IIA and compares it to the global trends of the past 10 years in a systematic review.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ruptured intracranial infectious aneurysms: Single Canadian center experience

Son

Mayich

Boulton

et al. 2022

Surgical Neurology International

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“…In most of the case, they are located at the distal MCA. 6,7 Antibiotic therapy is the cornerstone in the treatment of unruptured infectious aneurysms. In case of a rupture, surgical or endovascular treatment can be applied according to the clinical and radiological findings.…”

Section: Discussionmentioning

confidence: 99%

The Use of Real-Time 3D Intraoperative Ultrasound “Angiography” in Localization and Occlusion Control of a Ruptured Mycotic Aneurysm: A Case Report

Nerntengian

Gkasdaris

Barettas

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Infectious (mycotic) aneurysms are rare with high mortality and are most commonly found at the distal branches of the middle cerebral artery (MCA). Because aneurysms of the distal MCA are located deep in the Sylvian fissure and are small in size, intraoperative identification and safe clip occlusion of these aneurysms are challenging. Thus, the use of intraoperative imaging and navigation can be beneficial. We describe the use of intraoperative real-time 3D ultrasound “angiography” (3D-iUS) in localizing and occlusion control of a ruptured MCA M3 segment mycotic aneurysm. To our knowledge, its application in the surgery of a ruptured mycotic distal MCA aneurysm is not yet reported. Clinical Presentation A 54-year-old woman with a history of septic thrombophlebitis treated with long-term antibiotic therapy presented with sudden onset of headaches, dysphasia, and seizures. Computed tomography (CT) revealed subarachnoid hemorrhage in the distal portion of the left Sylvian fissure. Digital subtraction angiography (DSA) showed an aneurysm at the peripheral branch of the M3 segment of the MCA with characteristics of an infectious aneurysm. A microsurgical treatment was decided. 3D-iUS scan showed an aneurysm within the Sylvian fissure at a depth of 5 cm. The aneurysm was clipped and a repeated 3D-iUS scan showed total occlusion of the aneurysm and patency of the parent artery. The intraoperative findings were confirmed with a postoperative DSA. Conclusion Our case report shows that real-time 3D-iUS, despite its limitations, is an important tool to locate and ascertain the successful clip occlusion of an aneurysm, especially when intraoperative angiography (IA) and indocyanine green (ICG) videoangiography are not available due to low-income settings.

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“…Regarding the embolization material for endovascular treatment, detachable coils or liquid embolization agents (NBCA, onyx, or others) are used for IIA treatment. 1,3,4,7,10,13) Ding et al 8) reported a case with IIAs treated with stent assisted coil embolization. The induction of foreign materials into an infected vessel may cause prolongation of infection or abscess formation.…”

Section: Discussionmentioning

confidence: 99%

Treatment Strategies for Infectious Intracranial Aneurysms: Report of Three Cases and Review of the Literature

Ando

Hasegawa

Kikuchi

et al. 2019

Neurol. Med. Chir.(Tokyo)

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We retrospectively reviewed the cases of three patients with infectious intracranial aneurysms (IIAs), and discuss the indications for surgical and endovascular treatments. We treated two men and one woman with a total of six aneurysms. The mean age was 43.3 years, ranging from 36 to 51 years. One patient presented initially with an intraparenchymal hemorrhage, one with mass effect, and the other one had four aneurysms (one causing subarachnoid hemorrhages and the other causing delayed intraparenchymal hemorrhages). The average size of all aneurysms was 12.2 mm (range, 2-50 mm). They were preferentially located in the distal posterior cerebral artery, and then, in the middle cerebral artery. All cases were caused by infective endocarditis. We selected endovascular treatments for five aneurysms and treated all but one within 24 h from detection. One aneurysm was treated by combined therapy with endovascular intervention and surgery. After treatment, none of the IIAs presented angiographical recurrence or re-bleeding. If feasible, endovascular treatment is probably the first choice, but a combined surgical and endovascular approach should be considered if surgery or endovascular treatment alone are not feasible. The method of treatment should be individualized. For cases with high risk of aneurysm rupture, treatment should be performed as soon as possible.

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Endovascular Therapy for Infectious Intracranial Aneurysm: A Report of Four Cases

Cited by 19 publications

References 9 publications

Ruptured intracranial infectious aneurysms: Single Canadian center experience

Ruptured intracranial infectious aneurysms: Single Canadian center experience

The Use of Real-Time 3D Intraoperative Ultrasound “Angiography” in Localization and Occlusion Control of a Ruptured Mycotic Aneurysm: A Case Report

Treatment Strategies for Infectious Intracranial Aneurysms: Report of Three Cases and Review of the Literature

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