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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(04): 618-625
DOI: 10.1055/s-0044-1791268
Review Article

Endovascular Treatment of Mycotic Intracranial Aneurysms: A Series of Three Cases with Institutional Treatment Algorithm

Bheru Dan Charan 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, India
2   Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
Shailesh B. Gaikwad
2   Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
Sushant Agarwal
3   Department of Radiodiagnosis, Gauhati Medical College and Hospital, Guwahati, India
,
Savyasachi Jain
2   Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Mycotic intracranial aneurysms (MIAs) are rare but can cause significant morbidity and mortality due to rupture. Most patients have additional systemic medical comorbidities making endovascular treatment a vital modality in the treatment of these aneurysms. We aimed to share our institutional experience with the role of endovascular therapy in the treatment of mycotic aneurysms with a literature review. We conducted a retrospective review of our patient database to identify individuals diagnosed with MIAs who underwent endovascular intervention at our institution between January 2002 and December 2021. We have found three patients with ruptured MIAs. All three patients had a heart disease with infective endocarditis. Two patients presented with subarachnoid hemorrhage (SAH) in which, one had a rebleed resulting in intracerebral hemorrhage (ICH), the third patient initially presented with ICH. Distal anterior cerebral artery (ACA) was the site of MIA in two cases and distal middle cerebral artery (MCA) in one patient. Two patients were treated with simple coiling and one patient was treated by glue (n-butyl cyanoacrylate [NBCAs]) injection within the aneurysm. There was no periprocedural complication with complete obliteration of the aneurysm and preservation of the parent artery. All the patients had good outcomes on follow-up. Two patients had a modified Rankin scale (mRS) score of 0 at 6 months and one patient had an mRS score of 3 at the end of 3 months whose preprocedure mRS score was 5. Endovascular embolization of MIAs with coils or liquid embolic agents can be performed in critically ill patients and is an excellent treatment modality with high occlusion rates and low procedural complications.

Keywords

mycotic aneurysm - endovascular - subarachnoid hemorrhage - intracranial

Authors' Contributions

B.D.C., S.B.G., and S.A. contributed to the acquisition, analysis, conception, design, and drafting of the work. B.D.C., S.B.G., S.J., and S.A. contributed to the final draft, revisions, upload, and submission of the final revised work. All the authors have agreed to both be personally accountable for their contributions and ensure that questions related to the accuracy or integrity of any part of the work, even ones in which one was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.


Ethical Approval

This work was performed in accordance with the guidelines of the declaration of Helsinki.


Patients' Consent

Informed consent was waived owing to the retrospective nature of the study.




Publication History

Article published online:
30 September 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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