Medical Student Case Western Reserve University School of Medicine Cleveland, Ohio, United States
Introduction: Mycotic aneurysms represent a rare type of intracranial aneurysm. Treatment options usually consist of coiling, clipping, or liquid embolization. Data regarding outcomes following flow diversion (FD) of mycotic aneurysms are sparse. We present a single-center case series regarding our experience with flow diversion as definitive treatment for ruptured mycotic aneurysms initially treated with coil embolization.
Methods: We retrospectively reviewed a prospectively maintained database of all cerebrovascular procedures performed at a single institution between 2017 and 2021 for cases that used FD for the management of intracranial mycotic aneurysms. Prospectively collected data included patient demographics, past medical history, rupture status, aneurysm morphology, aneurysm location, and periprocedural complications. The main outcomes included neurological exam and radiographic occlusion rate on cerebral digital subtraction angiography.
Results: Three patients with four ruptured mycotic aneurysms that were initially treated with coil embolization were identified that required retreatment. The aneurysms were located along the middle cerebral artery bifurcation (n=2), posterior cerebral artery P1/2 junction (n=1), and basilar artery apex (n=1), which all demonstrated recurrence after initial coil embolization. Successful retreatment using flow diverting stents was performed in all 3 patients. At last angiographic follow-up, all aneurysms demonstrated complete occlusion. No patients suffered new periprocedural complications or neurological deficits following flow diversion.
Conclusion : Flow-diverting stents may be an effective treatment option for intracranial mycotic aneurysms that are refractory to previous endovascular coiling. Future studies are warranted to establish the associated long-term safety and clinical efficacy.
