Introduction: Infectious intracranial aneurysms are rare and potentially devastating complications of systemic infection. First line management is intravenous antibiotics, however in the setting of rupture, growth or failed medical therapy, surgical or endovascular management is indicated. Endovascular therapy for these aneurysms has become the dominant approach due to their small size and distal location. Furthermore, because the parent artery is often diseased or too small to reconstruct, vessel sacrifice is typically necessary. Liquid embolic agents seem particularly suited to treat these lesions due to their ability to fill the aneurysm and parent vessel.
Methods: We retrospectively reviewed the endovascular treatment of infectious aneurysms at a single institution from 2010-2012. Five patients with septic endocarditis harboring six infectious aneurysms were treated. Once the microcatheter was advanced into the aneurysm neck or dome, Onyx 18 was pushed until the aneurysm, proximal, and distal parent artery were filled. Confirmation of complete aneurysmal occlusion was made via repeat cerebral angiography.
Results: All patients presented with aneurysmal rupture resulting in subarachnoid hemorrhage (2), intraparenchymal hemorrhage (1), or a combination of intraparenchymal and intraventricular hemorrhage (2). The infected aneurysms ranged in size from 2 to 8 mm (median, 2.5 mm). Aneurysms were located in the distal MCA (4), the distal ACA (1), and distal PCA (1) territories. There were no procedural complications and the results of parent artery occlusions were asymptomatic. To date, five of the six aneurysms have been evaluated in follow up and confirmed to be durably and completely occluded. No patient has suffered a subsequent hemorrhage or brain abscess during a median follow up of 5.1 months (range, 2.5 to 12.4 months).
Conclusions: Treatment of infectious intracranial aneurysms via an endovascular approach using the liquid embolic agent Onyx appears to be safe and effective.
Patient Care: Establishing the safety and efficacy of liquid embolic agents for treatment of infectious intracranial aneurysms may limit the need for more invasive and morbid therapies.
Learning Objectives: To establish the safety and efficacy of treating infectious intracranial aneurysms endovascularly with the liquid embolic agent Onyx.