Endovascular treatment of infectious intracranial aneurysms

Abstract  

Infectious intracranial aneurysms (IIA) are rare but a considerable source of morbidity and mortality as a result of rupture. Most patients with these lesions have considerable medical comorbidities, making endovascular approaches a crucial modality in their treatment armamentarium. Contributing our own case, we performed a comprehensive review of the literature to illustrate overall results and outcomes for patients with IIA treated with endovascular approaches. Incorporating our own case, we found 65 patients harboring 72 IIA across 31 reports. Fifty-one were treated via parent artery occlusion (71 %), 17 via direct aneurysm embolization (24 %), two via stent-coiling (3 %), and two with stent monotherapy (3 %). Twenty-nine IIAs were treated with n‐butylcyanoacrylate (NBCA) (40 %), 25 with coils (35 %), seven with Onyx or ethylene vinyl alcohol (10 %), five with detachable balloons (7 %), four with stents (6 %), and one with autologous clot (1 %). One case of incomplete aneurysm occlusion and two cases of recanalization were reported. Six symptomatic periprocedural ischemic events were reported (9 %), with only three resulting in permanent sequelae (5 %). No infectious complications were reported. Incorporating the natural history of the disease, 28 patients were neurologically intact (43 %), while seven had died at the time of follow-up (11 %). Endovascular treatment of ruptured, symptomatic, or enlarging IIA is an excellent treatment modality with high occlusion rates and low procedure-related complication rates. Distal IIA are more often treated with parent artery occlusion, in our hands, preferentially with Onyx, while proximal lesions may be treated with direct stent-coiling or even flow-diverting stent monotherapy.

• Content Type Journal Article
• Category Review
• Pages 1-9
• DOI 10.1007/s10143-012-0414-1
• Authors
  • Bradley A. Gross, Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
  • Ajit S. Puri, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA

• Journal Neurosurgical Review
• Online ISSN 1437-2320
• Print ISSN 0344-5607

http://www.springerlink.com/content/ht4h06407k74v3u4/

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