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.

中文翻译：

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并发感染性心内膜炎的感染性颅内动脉瘤的血管内治疗：31 例 55 个动脉瘤的系列研究

目的

血管内治疗 (EVT) 已成为治疗并发感染性心内膜炎的感染性颅内动脉瘤 (IIAs) 的主要选择。我们报告了 EVT 治疗的 IIA 连续患者的回顾性、单中心系列。

方法

患者于 2009 年 1 月至 2020 年 7 月被纳入研究。IIA 是在 DSA 上诊断出来的。每位患者在 EVT 前后都接受了神经系统评估，并在 EVT 后 15 天内进行了影像学随访。根据 NIHSS 评分的演变评估安全性。轻微卒中定义为 NIHSS 恶化 < 4 分。疗效定义为心脏手术期间没有出血事件，并且在对照成像中排除了 IIA。

结果

31 名患者诊断出 62 处 IIA（30 处破裂）。在第一次 DSA 中诊断出 56 个 IIA，在早期控制探索中诊断出 6 个。在 55 个 IIA 中通过胶水在 52 个远端 IIA 中和在 3 个近端 IIA 中弹簧圈闭塞实现了 EVT。90.9% 的病例 IIA 位于大脑动脉的第四分支。29 例（93.5%）患者的神经系统检查保持不变，2 例患者出现轻微中风。20/22 名患者在心脏手术前进行了 EVT。在后续成像中排除了所有治疗的 IIA。在心脏手术期间或之后没有观察到出血。七个 (11.3%) 未破裂的 IIA 未栓塞。

结论

通过阻断载瘤动脉进行 IIA 的 EVT 可有效防止破裂，并且不会带来明显的神经系统风险。