Khayata M H, Aymard A, Casasco A, Herbreteau D, Woimant F, Merland J J
Department of Interventional Neuroangiography, Lariboisière Hospital, Paris University, France.
J Neurosurg. 1993 Apr;78(4):661-5. doi: 10.3171/jns.1993.78.4.0661.
The aim of this study was to evaluate the role of endovascular treatment for intracranial mycotic aneurysms. The clinical and angiographic features of three patients with endocarditic vegetation (two with Streptococcus viridans and one with Staphylococcus) were reviewed retrospectively. Patients were selected for this treatment according to the clinical setting and aneurysm location. In two cases, selective catheterization of a distal middle cerebral and posterior cerebral artery branch with a microcatheter followed by superselective amobarbital testing of the parent vessel was preliminary to the occlusion of that vessel with autologous clot or glue. The third patient was treated by selective occlusion of the aneurysm by intra-aneurysmal placement of platinum minicoils. Two patients presented with intracranial hemorrhage and in one the lesion was found on computerized tomography. All three aneurysms had been excluded from the circulation at the 6-month follow-up review. The only complication from the procedure, despite the septic nature and distal localization, was balloon deflation in one patient, who was successfully retreated with coils. Endovascular embolization is indicated in patients who are at risk of hemorrhage and cannot undergo the standard procedure. The superselective amobarbital test allows selection of patients who will tolerate distal vessel occlusion. This endovascular procedure represents a safe and effective treatment for these lesions.
本研究的目的是评估血管内治疗颅内真菌性动脉瘤的作用。回顾性分析了3例患有心内膜炎赘生物患者（2例为草绿色链球菌感染，1例为葡萄球菌感染）的临床和血管造影特征。根据临床情况和动脉瘤位置选择患者进行该治疗。在2例患者中，先用微导管对大脑中动脉远端分支和大脑后动脉分支进行选择性插管，然后对供血血管进行超选择性异戊巴比妥试验，之后用自体血凝块或胶水闭塞该血管。第3例患者通过在动脉瘤内放置铂微弹簧圈进行选择性动脉瘤闭塞治疗。2例患者出现颅内出血，1例患者的病变是在计算机断层扫描时发现的。在6个月的随访复查中，所有3个动脉瘤均已排除在血液循环之外。尽管该手术具有感染性且病变位于远端，但唯一的并发症是1例患者球囊瘪陷，该患者成功地再次使用弹簧圈进行了治疗。对于有出血风险且无法接受标准手术的患者，建议采用血管内栓塞治疗。超选择性异戊巴比妥试验可筛选出能耐受远端血管闭塞的患者。这种血管内手术是治疗这些病变的一种安全有效的方法。
