Introduction: With rising rates of intravenous (IV) drug use, complications of infective endocarditis are becoming more prevalent. Infectious Intracranial Aneurysms (IIAs) represent one type of these complications. To better understand current practice patterns and limits of current published literature, we performed a systematic review.
Methods: Pubmed search terms included: ‘Infectious Intracranial Aneurysm’, ‘mycotic cerebral aneurysm’, ‘cerebral mycotic aneurysm, and ‘intracranial infectious aneurysm’. We included retrospective and prospective publications 1/1980 to 5/2017. Manual search of references was also performed. We evaluated total publication number, patient and aneurysm number, ruptured status, mention of infective endocarditis, and treatment categories. Single case reports were included.
Results: 132 publications with a total of 499 patients and 665 aneurysms were included. Of the 499 patients, 83 were single case reports, of which 20.5% had multiple aneurysms. 35.8% of all aneurysms were ruptured. Of those reporting treatment, options included conservative antibiotic therapy (30.0%), surgical obliteration (31.1%), and endovascular occlusion (31.8%). Chronologically, publication of IIAs has increased (Figure 1). Furthermore, usage of endovascular therapies has grown, while conservative and surgical management have declined. In only 20.8% of patients was the issue of cardiac valve surgery in relationship to aneurysm therapy discussed. Of those reported, 3.1% underwent valve surgery before aneurysm treatment, while 17.5% underwent valve surgery after aneurysm treatment. Only 6.8% underwent valve surgery during their admission with the IIA.
Conclusions: Increasing trend of endovascular management of IIAs is evident. Details of cardiac surgery timing and patient outcome in IIA management of IE etiology is likely underreported, and warrants investigation to develop systems of practice for outcome optimization.
Patient Care: Our work will help providers understand trends in treatment of mycotic aneurysms and to understand the gravity of the current opioid epidemic and its medical complication of endocarditis-related intracranial aneurysms.
Learning Objectives: 1. Understand the published literature on treatment of mycotic aneurysms.
2. Recognize trends in disease prevalence in the literature and changing approaches to treatment.
3. Learn about the variance of approaches to addressing mycotic aneurysms in the context of concomitant endocarditis and related systemic complications.