Shi Hang, Parikh Neal S, Esenwa Charles, Zampolin Richard, Shah Harsh, Khasiyev Farid, Valenzuela Ives, Lavine Sean, Gutierrez Jose, Willey Joshua
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Clinical and Translational Neuroscience Unit, Feil Family Brain & Mind Research Institute and Weill Cornell Medicine, New York, NY, USA.
Neurohospitalist. 2021 Jan;11(1):5-11. doi: 10.1177/1941874420931233. Epub 2020 Jun 15.
Mycotic aneurysms (MA) are rare neurovascular complications of infective endocarditis (IE). The natural history and outcomes of MA under contemporary medical therapy have not been well characterized. The purpose of this study is to describe treatments and outcomes of patients with ruptured and unruptured MA in IE, specifically in relation to medical versus surgical/endovascular treatment.
Retrospective chart review was performed at 3 US academic medical centers of adult patients with IE and MA. Information was collected regarding risk factors, imaging, treatments, and outcomes, including ischemic stroke, intracerebral hemorrhage, MA size changes, and inhospital mortality.
Thirty-five patients with IE had 63 MA. Nineteen patients had at least one ruptured MA; 13 patients underwent invasive treatment and 6 received antibiotics alone. Of 19 patients on antibiotics alone (6 with at least one ruptured MA and 13 with unruptured MA), 14 underwent repeat imaging and 5 had enlarging MA. Of 16 patients treated invasively, 2 had unruptured MA initially treated with antibiotics but ultimately underwent intervention. No MA ruptured after aneurysm discovery. Fifteen patients underwent cardiothoracic surgery (CTS), of which 11 had unsecured MA and 4 had secured MA. No patients suffered perioperiative neurological events attributable to their MA. Three patients treated with antibiotics alone and 3 patients treated invasively died from causes unrelated to their MAs.
For patients with unruptured MA, treatment with antibiotics alone may have similar outcomes to invasive treatment. Further investigation is warranted to determine the risk of undergoing CTS with unsecured MA.
霉菌性动脉瘤（MA）是感染性心内膜炎（IE）罕见的神经血管并发症。当代医学治疗下MA的自然病史和转归尚未得到充分描述。本研究的目的是描述IE中破裂和未破裂MA患者的治疗方法及转归，特别是与药物治疗和手术/血管内治疗相关的情况。
在美国3家学术医疗中心对患有IE和MA的成年患者进行回顾性病历审查。收集有关危险因素、影像学检查、治疗方法及转归的信息，包括缺血性卒中、脑出血、MA大小变化及住院死亡率。
35例IE患者共有63个MA。19例患者至少有1个破裂的MA；13例患者接受了侵入性治疗，6例仅接受抗生素治疗。在仅接受抗生素治疗的19例患者中（6例至少有1个破裂的MA，13例未破裂的MA），14例接受了重复影像学检查，5例MA有增大。在接受侵入性治疗的16例患者中，2例最初未破裂的MA接受了抗生素治疗，但最终接受了干预。动脉瘤发现后无MA破裂。15例患者接受了心胸外科手术（CTS），其中11例MA未得到妥善处理，4例MA得到妥善处理。没有患者因MA发生围手术期神经系统事件。3例仅接受抗生素治疗的患者和3例接受侵入性治疗的患者死于与MA无关的原因。
对于未破裂MA患者，单纯抗生素治疗可能与侵入性治疗有相似的转归。有必要进一步研究以确定对未妥善处理的MA进行CTS的风险。
