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Abstract
Introduction With the current prominent usage of endovascular methods in managing intracranial aneurysms, understanding the value and role of these techniques to specifically address Infectious Intracranial Aneurysms (IIAs) is important. IIAs are often a complication of intravenous (IV) drug use. While these aneurysms carry high risk of rupture, there is some lack of consensus for optimal management. Furthermore, with the growing opioid epidemic, these lesions are likely to become more commonplace. To better understand current practice patterns and the role endovascular techniques occupy, we performed a systematic review.
Methods Pubmed search terms included: ‘Infectious Intracranial Aneurysm’, ‘mycotic cerebral aneurysm’, ‘cerebral mycotic aneurysm, and ‘intracranial infectious aneurysm’. We included retrospective and prospective publications 1/1980 to 5/2017. Manual search of references was also performed. We evaluated total publication number, patient and aneurysm number, ruptured status, mention of infective endocarditis, pathogen reported, treatment categories, failure, death, and rupture rates of conservative management and cardiac surgery timing. Single case reports were included.
Results 131 publications with a total of 499 patients and 665 aneurysms were included. Of the 499 patients, 83 were single case reports, and 20.5% of the total had multiple aneurysms. 35.8% of all aneurysms were ruptured. Chronologically, publication of IIAs has increased. Of those aneurysms where treatment options were reported 31.8% were managed endovascularly. Methods varied from parent artery occlusion using glue agents to coiling with or without stent assistance. Furthermore, usage of endovascular therapies has grown, while conservative (30.0% overall) and surgical management (31.1%) have declined in the literature. Of those managed endovascularly, only 5 unsuccessful attempts and 3 additional patient deaths were reported. By comparison, 56.2% of aneurysms for which conservative therapy was initiated eventually either underwent intervention, or death of the patient occurred. Of 51 patients who underwent cardiac valve surgery after aneurysm management, and for whom corresponding aneurysm treatment modality could be determined, 30 (51.7%) had undergone endovascular management.
Discussion Increasing trend of endovascular management of IIAs is evident. Strong consideration of endovascular methods as a predominant form of management for IIAs is warranted as the literature demonstrates both small rates of unsuccessful attempts/patient deaths. The literature also reflects the additional benefit of sooner subsequent cardiac surgery when aneurysms are treated via endovascular methods.
Disclosures R. Ragulojan: None. S. Grupke: None. J. Fraser: 1; C; University of Kentucky Department of Neurosurgery, University of Kentucky Department of Neurology, NIH CTSA UL1TR001998. 4; C; Fawkes Biotechnology, Stream Biomedical.