Selective endovascular techniques in the treatment of cerebral mycotic aneurysms

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.

Embolization of an Unruptured Distal Lenticulostriate Aneurysm Associated with Moyamoya Disease

“…6,11 This can be particularly useful in cases in which the aneurysm neck cannot be accessed by microcatheter and one is faced with sacrifice of the parent vessel, allowing avoidance of potentially devastating neurologic deficits.…”

Endovascular treatments for distal posterior cerebral artery aneurysms

“…Taken together, to achieve a satisfying prognosis, the types and locations of the aneurysms should be considered when performing the endovascular treatment for distal affected artery cavity using stents, reconstruction with stent in combination with coil embolization and coil embolization accompanied with occlusion of the parent artery (14,21,24). In both patients of our study, the arteries distal to the aneurysms were quite clear.…”

Management of Anterior Inferior Cerebellar Artery Aneurysms: Endovascular Treatment and Clinical Outcome

“…6,21,24,25,[29][30][31] The etiology of the AICA aneurysm is controversial: hemodynamic stress, embryonic vulnerability, flow-related vascular pathology, and arterial dissection by local trauma or nonspecific inflammation. 29,[32][33][34][35][36][37][38][39] Our study showed that 2 aneurysms were accompanied by AVMs and Moyamoya disease.…”