Flow-Diverter Stenting of Intracavernous Internal Carotid Artery Mycotic Aneurysm

• Published in: Journal of Stroke and Cerebrovascular Diseases Vol. 28; no. 7; pp. e81 - e82
• Main Authors: Imamura, Hirotoshi, Sakai, Nobuyuki, Alexander, Michael J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2019; Elsevier BV
• Subjects: Adult; Aneurysm, Infected; Aneurysm, Infected - diagnostic imaging; Aneurysm, Infected - microbiology; Aneurysm, Infected - physiopathology; Aneurysm, Infected - surgery; Angiography, Digital Subtraction; Anti-Bacterial Agents; Anti-Bacterial Agents - therapeutic use; Brucella; Brucellosis; Brucellosis - diagnostic imaging; Brucellosis - microbiology; Brucellosis - physiopathology; Brucellosis - surgery; Carotid Artery Diseases; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - microbiology; Carotid Artery Diseases - physiopathology; Carotid Artery Diseases - surgery; cavernous segment; Cerebral Angiography; Cerebral Angiography - methods; Cerebrovascular Circulation; Endovascular Procedures; Endovascular Procedures - instrumentation; flow diverter; Humans; Intracranial Aneurysm; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - microbiology; Intracranial Aneurysm - physiopathology; Intracranial Aneurysm - surgery; Magnetic Resonance Imaging; Male; Mycotic aneurysm; Prosthesis Design; Stents; Treatment Outcome; flow diverter; Mycotic aneurysm; cavernous segment; Brucella
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.026

This is the first reported case in which a mycotic aneurysm refractory to the first medical treatment was treated with a Pipeline embolization device (PED), and the first case of a mycotic aneurysm from Brucella treated by endovascular therapy. A 35-year-old man presented with left eye pain and ptosis, and fever for 2 weeks. Before symptom onset, he visited Vietnam where he developed a flu-like illness; however, antibiotics were ineffective. We suspected Brucella as the most likely infectious etiology for the patient's intracavernous aneurysm. Since the aneurysm did not reduce in size following 2 weeks of antibiotic therapy, we placed a PED in the left internal carotid artery. Follow-up angiogram 4 months later showed no residual aneurysm, and cranial nerve palsies had completely resolved. From the results of this case, it appears that flow diverter stenting may be a safe and effective treatment of mycotic aneurysms of the cavernous segment of ICA.