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Delicate mycotic aneurysms, thought to increase a patient's risk of intracranial hemorrhage, might be embolized safely with a liquid agent delivered endovascularly, a retrospective case series showed.
For all nine patients who required treatment for these intracranial aneurysms arising as a rare complication of infective endocarditis, a single rapid injection of Trufill n-butyl cyanoacrylate (n-BCA) -- with immediate microcatheter removal -- successfully blocked them off.
There were no complications associated with using n-BCA to prevent aneurysm bleeding, Muhammad S. Hussain, MD, of Cleveland Clinic, and colleagues reported online in Interventional Neurology.
"Endovascular embolization of infectious intracranial aneurysms with liquid embolics can be performed successfully in critically ill patients requiring immediate open heart surgery and anticoagulation," the authors concluded.
"The reason for cerebral angiography and endovascular embolization of the infectious aneurysms was the presence of intracerebral hemorrhage in four patients and preoperative treatment prior to open heart surgery in five patients since systemic heparinization was required during these surgeries," they noted.
"Early embolization prior to and within a short interval from open heart surgery is feasible." Two of the nine studied patients underwent open heart surgery within the same day as aneurysm embolization. No new hemorrhages were reported within 2 months of n-BCA injection.
Hussain's analysis encompassed nine consecutive patients with infective endocarditis and mycotic aneurysms who received endovascular administration of n-BCA from 2013 through 2015 at the Cleveland Clinic.
"Endovascular approach for embolization is evolving and becoming a more frequently used treatment option for infectious intracranial aneurysms," the authors wrote.
"Due to the parent vessel compromise and irregular morphology of these aneurysms, embolization frequently requires vessel sacrifice. This can be accomplished with coils and/or liquid embolics; however, the distal location and small caliber of the parent artery makes coil embolization not feasible in most cases, in whom endovascular embolization with liquid embolics may be the only treatment option."
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