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Endovascular treatment of infectious intracranial aneurysms complicating infective endocarditis: a series of 31 patients with 55 aneurysms

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Endovascular treatment (EVT) has become a major option in management of infectious intracranial aneurysms (IIAs) complicating infective endocarditis. We report a retrospective, single-center series of consecutive patients with IIAs treated by EVT.

Methods

Patients were included from January 2009 to July 2020. IIAs were diagnosed on DSA. Each patient underwent a neurological assessment before and after EVT and was followed up by imaging within 15 days of EVT. Safety was assessed on the evolution of NIHSS score. A minor stroke was defined as a worsening of NIHSS < 4 points. Efficacy was defined as the absence of hemorrhagic event during cardiac surgery and the exclusion of the IIA on control imaging.

Results

Sixty-two IIAs (30 ruptured) were diagnosed in 31 patients. Fifty-six IIAs were diagnosed on the first DSA and 6 on the early control exploration. EVT was achieved in 55 IIAs by parent artery occlusion with glue in 52 distal IIAs and coils in 3 proximal IIAs. IIAs were located in 90.9% of cases on a fourth-division branch of a cerebral artery. The neurological examination remained unchanged in 29 patients (93.5%), and 2 patients suffered minor stroke. EVT was performed before cardiac surgery in 20/22 patients. All treated IIAs were excluded on follow-up imaging. No hemorrhage was observed during cardiac surgery or in the aftermath. Seven (11.3%) unruptured IIAs were not embolized.

Conclusion

EVT of IIAs by occlusion of the parent artery is effective in preventing rupture and carries no significant neurological risk.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

Abbreviations

ACA:

Anterior cerebral artery

EVT:

Endovascular treatment

IIA:

Infectious intracranial aneurysm

IQR:

Interquartile range

SD:

Standard deviation

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Author notes

  1. Fabiola Serrano and Alexis Guédon contributed equally to the work

Authors and Affiliations

  1. Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France

    Fabiola Serrano, Alexis Guédon, Jean-Pierre Saint-Maurice, Marc-Antoine Labeyrie, Vittorio Civelli, Michael Eliezer & Emmanuel Houdart

  2. University of Paris, Paris, France

    Alexis Guédon & Emmanuel Houdart

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  1. Fabiola Serrano
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Contributions

Conception and design: FS, AG, and EH. Acquisition of data: FS, AG, and EH. Analysis and interpretation of data: FS, AG, and EH. Drafting the article: FS, AG, and EH. Critical revision of the article: JPSM, MAL, VC, and ME. Review of submitted version of manuscript: FS, AG, JPSM, MAL, VS, ME, and EH. Approval of the final version of the manuscript on behalf of all authors: AG.

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Correspondence to Alexis Guédon.

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The manuscript has been approved by the institutional review board without patient informed consent required and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and national laws (CNIL N° 2221622).

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Serrano, F., Guédon, A., Saint-Maurice, JP. et al. Endovascular treatment of infectious intracranial aneurysms complicating infective endocarditis: a series of 31 patients with 55 aneurysms. Neuroradiology 64, 353–360 (2022). https://doi.org/10.1007/s00234-021-02798-5

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