Endovascular Treatment of Cerebral Mycotic Aneurysm: A Review of the Literature and Single Center Experience

Zanaty, Mario; Chalouhi, Nohra; Starke, Robert M.; Tjoumakaris, Stavropoula; Gonzalez, L. Fernando; Hasan, David; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1155/2013/151643

Cited by 72 publications

(62 citation statements)

References 45 publications

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“…Nevertheless, a purely conservative treatment regimen seems to be a possible alternative for multimorbid patients with unruptured aneurysms in whom surgical or endovascular interventions are associated with high risks [72]. Peters et al [4] also suggests this approach for non-multimorbid patients with smaller unruptured aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Hamisch¹,

Mpotsaris

Timmer³

et al. 2016

Cerebrovasc Dis

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Objective: Intracranial infectious aneurysms (IIAs) are a rare clinical entity without a definitive treatment guideline. In this study, we evaluate the treatment options of these lesions based on our own clinical experience and review the current knowledge of therapy as portrayed in the literature. Methods: We conducted a single-center retrospective analysis of all patients with an IIA and performed a systematic review of the literature using the MEDLINE database. We undertook a comprehensive literature search using the OVID gateway of the MEDLINE database (1950-October 2015) using the following keywords (in combination): ‘infectious', ‘mycotic', ‘cerebral aneurysm', ‘intracranial aneurysm'. 1,721 potentially relevant abstracts were identified and 63 studies were selected for full review. The studies were analysed regarding ruptured versus unruptured aneurysms, aneurysm localization and treatment, as well as clinical and radiological outcome. Results: Our institutional series consisted of 6 patients (median age 57 [32-76]) treated between 2011 and 2015. All patients presented with ruptured IIAs located on the middle cerebral artery (MCA, 5 patients) and anterior cerebral artery (ACA, 1 patient). Five patients were treated by clipping and resecting the aneurysm, 1 patient underwent coiling. All patients received antibiotic therapy and 1 patient died. We further identified 814 patients (median age 35.5 [0-81]) in 63 studies. Locations of the aneurysms were mentioned in 55 studies. The most frequent locations of the aneurysms were: MCA (63.5%), posterior cerebral artery (14%), ACA (9.0%) and others (13.5%). Treatment for IIAs was described in 62 studies: antibiotic treatment (56.1%), a combination of antibiotics and surgery (20.9%) or antibiotics and endovascular treatment (23.0%). Outcome was mentioned in 82.4% of the patients with a mortality rate of 16.8%. An evaluation of treatment outcome was limited due to the heterogeneity of patients in the published case series. Conclusion: Antibiotic therapy of patients with IIA is mandatory. However, due to the complexity of the disease and its accompanying comorbidities, a general treatment algorithm could not be defined. Analogous to non-mycotic aneurysms, further treatment decisions require an interdisciplinary approach involving neurosurgeons, interventionists and infectious disease specialists.

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Section: Discussionmentioning

confidence: 99%

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Hamisch¹,

Mpotsaris

Timmer³

et al. 2016

Cerebrovasc Dis

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“…Mycotic aneurysms tend to favor the anterior circulation-the middle cerebral artery and its distal branches in particular (31). The location of intracranial mycotic aneurysms is less predictable than that of nonmycotic aneurysms, as mycotic dilatations reportedly have been identified in many locations, including the basilar system, around the circle of Willis, and in the distal branches of the cerebral arteries (32)(33)(34)(35).…”

Section: Intracranial Mycotic Aneurysmmentioning

confidence: 99%

“…Pressure from sustained arterial pulsatile flow in conjunction with a thin friable wall predisposes the aneurysm to rupture. Rupture of the vessel wall can lead to infarction as well as subarachnoid, intraparenchymal, and/or intraventricular hemorrhage (31). The mortality rate associated with a ruptured mycotic aneurysm can be as high as 80% (31,36).…”

Section: Intracranial Mycotic Aneurysmmentioning

confidence: 99%

“…Rupture of the vessel wall can lead to infarction as well as subarachnoid, intraparenchymal, and/or intraventricular hemorrhage (31). The mortality rate associated with a ruptured mycotic aneurysm can be as high as 80% (31,36). Early detection and subsequent medical management, endovascular coil placement, and/ or surgical management can lead to substantially improved patient survival (31).…”

Section: Intracranial Mycotic Aneurysmmentioning

confidence: 99%

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Acute Radiologic Manifestations of America’s Opioid Epidemic

Bates

Gallagher

et al. 2018

RadioGraphics

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The United States is in the midst of an opioid use epidemic, which has severe medical, social, and economic consequences. Addictions to and abuse of prescription and illicit opioids are increasing, and emergency department radiologists are increasingly being faced with the task of examining patients who present with opioid-related complications. These complications may be the result of direct drug toxicity or nonsterile injection of the drugs. Neurologic, musculoskeletal, cardiopulmonary, genitourinary, and gastrointestinal complications may be evident at diagnostic imaging in emergent settings. Heroin-induced leukoencephalopathy, cerebral septic emboli, mycotic arterial aneurysms, soft-tissue infections, and infective endocarditis are some of the conditions that patients may be found to have after they present to the emergency department. In this article, the above topics, including clinical features, pathophysiology, imaging findings, and treatment options, are reviewed. Recognizing the limitations of diagnostic imaging modalities that are available to radiologists is equally important, as some conditions can be successfully diagnosed after the initial triage-for example, transesophageal echocardiography can be performed to diagnose infective endocarditis. The emergency department radiologist may be responsible for identifying acute conditions, which can be life threatening. Some of the more common emergent opioid-related conditions and complications are reviewed, with specific emphasis on cases in which emergency department radiologists encounter conditions for which additional expertise is required. Becoming familiar with the conditions directly related to the current opioid epidemic will enable the diagnosis of these entities in a timely and accurate manner. RSNA, 2018.

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“…The administration of appropriate antibiotics is one of the most important treatments. 1,2) Because the disease is fatal, rapid diagnosis and appropriate treatments are essential.…”

Section: Introductionmentioning

confidence: 99%

Differentiating between Mycotic and Dissecting Aneurysms in a Case of Ruptured Distal Superior Cerebral Artery Aneurysm

Miki

Natori

Yang

et al. 2020

JNET

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Objective:We present a case of subarachnoid hemorrhage (SAH) due to ruptured mycotic aneurysm found in the distal superior cerebellar artery (SCA). Case Presentation:A 64-year-old man was admitted to our hospital with sudden unconsciousness. He had a history of alcoholism but no family history of SAH. Computed tomography (CT) showed apparent SAH; however, CT angiography (CTA) showed no apparent cause of SAH except for two small aneurysms in the same branch of the left distal SCA. We suspected mycotic aneurysm and prescribed antibiotics. It was difficult to diagnose the condition as mycotic aneurysm because there were no vegetations or caries at the time of admission. Because there were two aneurysms in the same branch with partial dilatation and stenosis, we suspected dissecting aneurysm, but continued to administer antibiotics for possible mycotic aneurysm. After the first operation, we diagnosed mycotic aneurysm because a vegetation and valve degeneration was found.Conclusion: It is difficult to distinguish mycotic aneurysms from dissecting aneurysms because of similar appearance on imaging, especially if no vegetation is found. Nevertheless, it is important to start treatment for mycotic aneurysm. If there is the possibility of mycotic aneurysm, appropriate antibiotics should be administered, and endovascular treatment could be considered for patients with deteriorating conditions.

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Endovascular Treatment of Cerebral Mycotic Aneurysm: A Review of the Literature and Single Center Experience

Cited by 72 publications

References 45 publications

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Acute Radiologic Manifestations of America’s Opioid Epidemic

Differentiating between Mycotic and Dissecting Aneurysms in a Case of Ruptured Distal Superior Cerebral Artery Aneurysm

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