Introduction: The best management for mycotic cerebral aneurysms (CA) is not well understood due to their rarity.Treatment strategies may include antibiotics alone, surgery or endovascular treatment of CA, cardiac surgery for infected cardiac valve, or some combination.We performed a Nationwide Inpatient Sample(NIS) database query to understand treatment practices in the United States.

Methods: We queried the NIS database from 2002 to 2011 for all patients with infective endocarditis(IE) and CA.SAS software package(Cary,NC,V.9.3) was used to calculate descriptive statistics and conduct statistical tests.

Results: We found 632 patients (mean age = 55.3 years) with IE and CA.The majority of patients presented with SAH (558; 88.3%).Mortality was 35.6% in patients with SAH and 4.1% in those with unruptured aneurysms(p value < .0001).Only 11.6% patients with SAH and 20.3% patients with unruptured aneurysms underwent surgery or endovascular treatment for CA (36% surgery;64% endovascular).Likewise, only 13.8% of patients with SAH and 13.5% with unruptured aneurysms underwent a cardiac procedure.The proportion of patients receiving cardiothoracic or neurosurgical procedures has remained roughly constant over the years 2002-2011 even though total number of patients who underwent the procedures has increased.About 58% patients with SAH and 25% patients with unruptured aneurysms had poor outcomes as defined by discharge disposition.Mortality was significantly higher in patients managed non-operatively(p value< .001).Length of stay and hospital charges were higher in patients who underwent intervention(p value< .0001).Patients in large hospitals are significantly more likely to receive brain procedures(OR=4.5,CI=[1.81, 11.4], p=.001).Patients in teaching hospitals are significantly more likely to receive a cardiac procedure(OR=3.6,95% CI=[1.61, 7.92], p=.002).

Conclusions: In this NIS database study,majority of patients with mycotic CA were managed non-operatively, regardless of rupture status.The proportion of patients undergoing any intervention has remained constant over the years 2002-2011 although number of patients with IE and mycotic CA has increased.Further investigations seem warranted to standardize the management to improve outcomes.

Patient Care: 1. This study will demonstrate national management practices and outcomes in patients with infective endocarditis and mycotic intracranial aneurysms which will guide physicians taking care of such patients.

Learning Objectives: Current trends in the management of mycotic intracranial aneurysms.

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