Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France.
University of Paris, Paris, France.
Neuroradiology. 2022 Feb;64(2):353-360. doi: 10.1007/s00234-021-02798-5. Epub 2021 Aug 30.
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.
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.
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.
EVT of IIAs by occlusion of the parent artery is effective in preventing rupture and carries no significant neurological risk.
血管内治疗（EVT）已成为治疗感染性心内膜炎并发感染性颅内动脉瘤（IIAs）的主要方法。我们报告了一系列连续的 IIAs 患者接受 EVT 治疗的回顾性单中心研究。
患者入选时间为 2009 年 1 月至 2020 年 7 月。DSA 诊断 IIAs。每位患者在 EVT 前后均进行神经学评估，并在 EVT 后 15 天内进行影像学随访。安全性通过 NIHSS 评分的演变进行评估。轻度中风定义为 NIHSS 恶化<4 分。疗效定义为心脏手术期间无出血事件且 IIA 在对照影像学上排除。
31 例患者共诊断出 62 个 IIAs（30 个破裂）。56 个 IIAs 在首次 DSA 诊断，6 个在早期的控制探查中诊断。通过胶栓塞母动脉闭塞治疗 55 个 IIAs，其中 52 个 IIAs位于远端，3 个位于近端。22 例患者中，20 例在心脏手术前进行了 EVT。90.9%的 IIAs位于大脑动脉的第四分支。29 例患者（93.5%）神经检查无变化，2 例发生轻度中风。20/22 例接受治疗的 IIAs 均在随访影像学上排除。心脏手术或术后无出血。7 个（11.3%）未破裂的 IIAs未进行栓塞。
通过闭塞母动脉治疗 IIAs 有效预防破裂，且无明显的神经风险。
