Endovascular Management of Ruptured Cerebral Mycotic Aneurysms

The purpose of this investigation was to evaluate the current endovascular management of cerebral mycotic aneurysms. We report the retrospective evaluation of data of patients with cerebral mycotic aneurysms treated with endovascular approach. Thirteen consecutive patients with cerebral mycotic aneurysms were treated between April 2001 and March 2007. There were seven men and six women with ages ranging from 20 to 52 years (mean age 33 years.). All 13 patients had rheumatic heart disease (RHD) with endocarditis. The aneurysms were located within the distal cerebral circulation (n = 12) or in the circle of Willis (n = 1). All were ruptured aneurysms. Distal aneurysms were treated by parent vessel occlusion. Proximal saccular aneurysms were selectively treated. Endovascular treatment was technically successful in all patients. No patient had a rebleed after embolization during the clinical follow-up. Two patients deteriorated and died after endovascular treatment. Repeat CT scan showed increased mass effect because of earlier intracerebral bleed. The late clinical outcome in the other 11 patients was normal neurological status (n = 8) or permanent disability that was related to the initial stroke (n = 3). Endovascular approach is a reliable and safe technique for management of cerebral mycotic aneurysms.