Endovascular treatment of infectious intracranial aneurysms: A single-center experience

被引:0
作者
Patel, Smit D. [1 ]
Balabhadra, Anvesh A. [2 ]
Miller, Ethan A. [2 ]
Gandhi, Isha S. [3 ]
Patel, Neel [4 ]
Fowler, James [2 ]
Tunguturi, Ajay [2 ]
Otite, Fadar Oliver [5 ]
Bruno, Charles [2 ]
Sussman, Eric [2 ]
Ollenschleger, Martin [2 ]
Mehta, Tapan [2 ]
机构
[1] St Francis Hlth Syst, Dept Neurointervent Radiol, Tulsa, OK 74136 USA
[2] Hartford Hosp, Dept Neurointervent Radiol, Hartford, CT USA
[3] Univ Connecticut, Dept Physiol & Biol, Storrs, CT USA
[4] Icahn Sch Med, Dept Publ Hlth, New York, NY USA
[5] SUNY Upstate Med Univ, Dept Neurol, Syracuse, NY USA
关键词
Drug abuse; hemorrhagic stroke; infective aneurysms; infective endocarditis; ischemic stroke; mycotic aneurysms; stroke in young; EFFICACY; SAFETY;
D O I
10.4103/bc.bc_77_24
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
INTRODUCTION:Infectious intracranial aneurysms (IIAs), a notable complication of infective endocarditis (IE), pose significant clinical challenges. This study delineates the outcomes, management strategies, and clinical manifestations of IIAs, drawing from a single-center's experience. METHODS:We conducted a retrospective observational analysis at our institution, focusing on patients diagnosed with IE between 2016 and 2022 who were also found to have IIAs. Data analysis was performed utilizing SAS statistical software alongside Microsoft Excel to execute descriptive statistical operations. RESULTS:Among 862 IE patients, 25 (2.9%) were diagnosed with IIAs, totaling 41 mycotic aneurysms. Of these, 18 patients had a single aneurysm, while 7 had multiple. The cohort's median age was 45 years, with an interquartile range of 27-65 years, and a predominance of male patients (68.3%). Ischemic and hemorrhagic strokes were observed in 58.6% and 87.8% of the cases, respectively. Ruptured IIAs were noted in 58.5% of instances, with the remainder unruptured. The average diameter of ruptured IIAs was 3.3 mm, compared to 2.1 mm for unruptured aneurysms, although this difference was not statistically significant (P = 0.324). The most frequent IIA locations were the distal segments of the posterior and middle cerebral arteries. Patients with ruptured IIAs experienced higher in-hospital mortality rates (29.1%) relative to those with unruptured IIAs (11.7%). Treatment was administered to 58.3% of ruptured IIAs, with no interventions for unruptured aneurysms (P = 0.001). Treatment modalities included surgical resection, n-butyl cyanoacrylate, coils, and Onyx embolization. The treated ruptured IIAs had an average size of 4.4 mm, versus 2.0 mm for untreated aneurysms. Among those treated, the majority were either discharged home (21.4%) or to other facilities (78.6%), with no in-hospital mortalities reported in this group. CONCLUSION:The findings suggest that endovascular treatment is a viable and effective option for managing ruptured IIAs, with decisions tailored to individual patient comorbidities. Further multicenter studies are recommended to corroborate these findings and refine treatment strategies for IIAs associated with infective endocarditis.
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收藏
页码:24 / 29
页数:6
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