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

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Abstract: 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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