Evaluating the Safety and Efficacy of Various Endovascular Approaches for Treatment of Infectious Intracranial Aneurysms: A Systematic Review.

OBJECTIVE: A review of endovascular cerebral mycotic aneurysm treatment with Onyx liquid embolic, N-butyl-2-cyanoacrylate (NBCA), or coil embolization has not been reported. The authors conduct a systematic review on endovascular treatment methods of mycotic aneurysms. METHODS: A systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986 and 2020. All studies assessing outcomes related to endovascular Onyx embolization, NBCA embolization, or coiling were included. RESULTS: A total of 73 studies were ultimately selected including 180 (67% male) patients comprising 243 aneurysms treated endovascularly. The mean age was 38.2 ± 17.6 years, and the most common symptom on presentation was headache (31%). Most aneurysms were located on the middle cerebral artery (52.5%), and over half presented with rupture (53.8%). Coiling was the most commonly employed technique (50.4%), and obliteration rates were comparable across coiling, NBCA, and Onyx (99.1%, 100%, 100%, respectively). Complication rates were also comparable (4.3% vs. 15.2% vs. 8.1%). CONCLUSIONS: Embolization for infectious intracranial aneurysm appears to be an effective treatment option for mycotic aneurysms. Embolization rates were comparable among coiling, NBCA, and Onyx embolization. Noninferiority among these modalities cannot be demonstrated given the retrospective nature of this review, evolution of endovascular techniques over the years, and changes in treatment paradigms in the past 2 decades. Ideally, further prospective research will be necessary to find which treatment method offers the lowest complication rates and the best outcomes for patients with mycotic aneurysms.

Ruptured mycotic thoracic aortic aneurysm: lobectomy and dacron graft repair.

A 57-year-old man presenting with hemoptysis and chest pain was diagnosed to have a Staphylococcus aureus mycotic aneurysm of the descending thoracic aorta, which subsequently ruptured into the left lower lobe of the lungs. He underwent successful repair with lung resection and Dacron graft replacement under hypothermic circulatory arrest, followed by long-term antibiotic therapy.

Use of dacron vascular prosthesis impregnated with salts of silver, in treatment of extraanatomical axilla-femoral by-pass's infection. Infections in vascular surgery.

We presented a case of use a dacron prosthesis, bonded with collagen and impregnated with salts of silver in the treatment of extraanatomical axilla-femoral by-pass infection, by-pass was made at 78-years-old patient cause of an acute ischaemia of the lower extremity caused by an inoperative inflammatory aneurysm of abdominal aorta and iliac arteries. Firstly intentional antibiotics were administered. The patient was again admitted to hospital and operated on after an ineffective preventive treatment. The infected prosthesis was replaced by a new, salts of silver impregnated dacron one with increased infection resistance. The clinical effect was successful.

Successful endovascular treatment of rupture of mycotic left main coronary artery aneurysm.

Mycotic coronary aneurysm formation is a rare complication in patients with infective endocarditis. Furthermore, rupture of coronary artery aneurysm, also rare, is life threatening. Sudden rupture of left main mycotic coronary aneurysm occurred in a patient, aged 68 years, 1 month after root replacement for aortic regurgitation caused by infectious endocarditis. A polytetrafluoroethylene-covered stent was implanted covering the entire aneurysmal portion crossing over the left circumflex coronary artery in this emergent situation. After a successful hemostatic procedure, the patient recovered from cardiogenic shock. We confirmed the sustained patency of the stent segment by coronary angiography 6 months after the procedure.

Contained rupture of an inflammatory abdominal aortic aneurysm into the iliopsoas muscle: report of a case.

A 72-year-old man with a history of old myocardial infarction was admitted to our hospital for surgical treatment of a ruptured abdominal aortic aneurysm. His hemodynamics was stable. He had left lumbar pain on moving his left leg and constipation for ten days without abdominal pain and high fever. Elevation of fat density around the aneurysm and ureter involvement were noted on the computed tomography. These characteristic image findings indicated inflammatory aortic aneurysm. During operation, an infrarenal abdominal aortic aneurysm with an 8 cm maximum diameter was noted. This aneurysm was firm and thick and adhered to some organs due to inflammation. An 5 × 5 cm punched-out defect was found on the lateral wall of the aneurysm. We replaced the ruptured aneurysm with a Dacron graft. Histological examination showed that the aneurysm wall had an infiltrate of inflammatory cells, lymphoid follicles and thickened adventitia. From these findings, the diagnosis was inflammatory aortic aneurysm.

Infectious aneurysm of the cavernous carotid artery in a child treated with a new-generation of flow-diverting stent graft: case report.

OBJECTIVE: To report a unique case of wide-necked mycotic cerebral aneurysm treated with a new generation of intracranial stent. CLINICAL PRESENTATION: A 10-year-old girl presented with meningitis complicated by an infectious intracavernous large aneurysm revealed by cranial nerve palsy. INTERVENTION: The aneurysm was treated by a new-generation, flow-diverting, endoluminal implant (SILK; BALT EXTRUSION, Montmorency, France) placed across the aneurysm neck without coiling. Angiographic controls showed complete thrombosis of the aneurysmal sac with dramatic improvement of symptoms a couple of weeks after the procedure. Follow-up magnetic resonance imaging and digital subtraction angiography 3 months after the procedure, confirmed total occlusion of the aneurysm with normal circulation in the parent vessel CONCLUSION: This is a simple and highly effective way to exclude an aneurysm from the parent vessel without the difficulties observed with the semi-rigid stents. Flow-disrupting stent grafting may be a safe and effective alternative treatment for large intracranial aneurysms.

Ruptured abdominal aortic aneurysms due to Salmonella, not of typhi species.

Ruptured aortic aneurysms due to Salmonella not of typhi species are rare and associated with high morbidity and mortality. We present three patients with Salmonella-infected ruptured aortic aneurysms successfully treated with an in situ prosthetic bypass graft. One patient had a saccular aneurysm at the infrarenal aorta and two patients had fusiform aneurysms at the aortic bifurcation. All the patients were treated with wide debridement of the infected aortic tissue followed by in situ graft replacement and long-term systemic antibiotic therapy. The method of revascularization, in situ bypass or extraanatomic bypass, remains controversial. On the basis of our clinical experience and recent literature focusing on more than 10 cases, in situ bypass reconstruction may be a feasible surgical technique for Salmonella-infected ruptured aortic aneurysm.

[Neisseria mucosa endocarditis complicated by intracerebral aneurysm]. / Endocardite à Neisseria mucosa compliquée d'anévrysmes intracérébraux.

BACKGROUND: Serious complications, such as emboli and mycotic aneurysms, are still frequent in documented cases of infective endocarditis. Infecting organisms other than Streptococcus viridans and Staphylococcus are becoming more common. CASE REPORT: A 8 year-old girl was admitted because of a sudden pain in the right calf followed by complete disability. She had low-grade fever and presented with a moderate heart murmur with no sign of congestive heart failure, a severe pain at palpation of her calf with no Homans sign; she had many dental caries. Laboratory data indicated leukocytosis with increased percentage of polymorphonuclear cells and increased sedimentation rate. Ultrasonography of the calf showed laceration of the muscle with blood suffusion. Echocardiography showed vegetations involving the mitral valve. Intravenous antibiotic therapy with penicillin G and netilmicin was instituted, but mitral insufficiency appeared 7 days later while the fever persisted. At that time, the brain CT scan showed ischemic lesions, while angiography showed several mycotic aneurysms. Neisseria mucosa was recovered from the 5 initial blood cultures 16 days after the onset, and penicillin G was replaced by ampicillin. A second vegetation involving the aortic valve was seen a few days later, and a recent arterial embolism to the right leg was suspected because fever and pain reappeared. The brain ischemic lesions gradually disappeared and a second angiography performed 3 months after the first showed that all but one large mycotic aneurysm had disappeared; this last aneurysm was excised. Four years later, the child is in good health without any neurological sequelae but having mitral insufficiency. CONCLUSION: This girl presented with classical complication of infective endocarditis due to Neisseria mucosa, a saprophytic organism of the oral cavity. This is the second report of such an infection in children.