Purkayastha Sukalyan, Kumar Rajinder, Verma Dinesh, Dhurvey Deepak, Kumar Nitin, Jana Surajit
Department of Neurointervention, Institute of Neuroscience, Kolkata, India.
Neurointervention. 2024 Nov;19(3):156-161. doi: 10.5469/neuroint.2024.00290. Epub 2024 Oct 16.
Intracranial mycotic aneurysms (IMAs), rare and often life-threatening, result from arterial wall infections typically caused by bacteria such as Staphylococcus and Streptococcus. The standard treatment for ruptured aneurysms is not well-defined and often individualized. This study investigates the efficacy of endovascular glue embolization in managing ruptured IMAs, based on our center's experience.
A retrospective analysis was conducted for ruptured IMAs treated with glue embolization between January 2016 and December 2023. The procedure involved aneurysm sac and parent vessel occlusion with glue delivery. Data included patient demographics, clinical presentations, and neuroimaging. Clinical outcomes were assessed using the modified Rankin scale (mRS) at 3 months, and angiographic follow-up was conducted at 6 months.
The study included 28 patients, predominantly male (64.3%), with a mean age of 48 years. Headache was the primary symptom in 92.9% of cases, and positive blood/cerebro spinal fluid cultures were found in 82.14% of cases. All aneurysms were located in the distal circulation, primarily in the anterior circulation system. Glue embolization was successfully performed in all cases, achieving complete aneurysm sac and parent vessel obliteration. Follow-up at 3 months indicated mRS scores of 0 or 1 in 96.5% of cases. Six-month angiographic follow-up showed no aneurysm regrowth or new formations.
Endovascular glue embolization demonstrated high efficacy and safety in treating ruptured IMAs, with a 100% obliteration rate and favorable clinical outcomes in this single-center experience. Despite limitations such as its retrospective design and small sample size, the study supports glue embolization as a viable, less invasive alternative to traditional surgery. Further comparative studies are needed to confirm these findings and refine treatment approaches.
颅内真菌性动脉瘤（IMA）较为罕见且常危及生命，是由动脉壁感染引起的，通常由葡萄球菌和链球菌等细菌所致。破裂动脉瘤的标准治疗方法尚不明确，且往往因人而异。本研究基于我们中心的经验，探讨血管内胶水栓塞术治疗破裂IMA的疗效。
对2016年1月至2023年12月期间接受胶水栓塞术治疗的破裂IMA进行回顾性分析。该手术包括用胶水封堵动脉瘤囊和供血动脉。数据包括患者人口统计学资料、临床表现和神经影像学检查。在3个月时使用改良Rankin量表（mRS）评估临床结局，并在6个月时进行血管造影随访。
该研究纳入28例患者，以男性为主（64.3%），平均年龄48岁。92.9%的病例以头痛为主要症状，82.14%的病例血液/脑脊液培养呈阳性。所有动脉瘤均位于远端循环，主要在前循环系统。所有病例均成功进行了胶水栓塞，实现了动脉瘤囊和供血动脉的完全闭塞。3个月的随访显示，96.5%的病例mRS评分为0或1。6个月的血管造影随访显示无动脉瘤复发或新形成。
在本单中心经验中，血管内胶水栓塞术在治疗破裂IMA方面显示出高疗效和安全性，闭塞率达100%，临床结局良好。尽管存在回顾性设计和样本量小等局限性，但该研究支持胶水栓塞术作为传统手术的一种可行、侵入性较小的替代方法。需要进一步的比较研究来证实这些发现并完善治疗方法。
