Selective endovascular techniques in the treatment of cerebral mycotic aneurysms

Report of three cases

Mazen H. Khayata Departments of Interventional Neuroangiography and Neurology, Lariboisière Hospital, Paris University, Paris, France: and Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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 M.D.
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Armand Aymard Departments of Interventional Neuroangiography and Neurology, Lariboisière Hospital, Paris University, Paris, France: and Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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Alfredo Casasco Departments of Interventional Neuroangiography and Neurology, Lariboisière Hospital, Paris University, Paris, France: and Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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 M.D.
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Denis Herbreteau Departments of Interventional Neuroangiography and Neurology, Lariboisière Hospital, Paris University, Paris, France: and Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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France Woimant Departments of Interventional Neuroangiography and Neurology, Lariboisière Hospital, Paris University, Paris, France: and Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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Jean Jacques Merland Departments of Interventional Neuroangiography and Neurology, Lariboisière Hospital, Paris University, Paris, France: and Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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Page Range:
661–665
Volume/Issue:
Volume 78: Issue 4
DOI link:
https://doi.org/10.3171/jns.1993.78.4.0661
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✓ 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.

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Contributor Notes

Address for Dr. Khayata: Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.
Address for Dr. Woimant: Neurology Department, Lariboisière Hospital, Paris, France.
Address reprint requests to: Jean Jacques Merland, M.D., Interventional Neuroangiography, Lariboisière Hospital, Paris University, 2 Rue Ambroise Pare, 75010 Paris, France.
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