Neurointervention.  2024 Nov;19(3):156-161. 10.5469/neuroint.2024.00290.

Efficacy of Endovascular Glue Embolization in Treating Ruptured Intracranial Mycotic Aneurysms: A Single Center Experience

• Purkayastha S
• Kumar R
• Verma D
• Dhurvey D
• Kumar N
• Jana S

• KMID: 2560219
• DOI: http://doi.org/10.5469/neuroint.2024.00290

Abstract

Purpose
Intracranial mycotic aneurysms (IMAs), rare and often life-threatening, result from arterial wall infections typically caused by bacteria such as Staphylococcus and Streptococcus. The standard treatment for ruptured aneurysms is not well-defined and often individualized. This study investigates the efficacy of endovascular glue embolization in managing ruptured IMAs, based on our center’s experience.
Materials and Methods
A retrospective analysis was conducted for ruptured IMAs treated with glue embolization between January 2016 and December 2023. The procedure involved aneurysm sac and parent vessel occlusion with glue delivery. Data included patient demographics, clinical presentations, and neuroimaging. Clinical outcomes were assessed using the modified Rankin scale (mRS) at 3 months, and angiographic follow-up was conducted at 6 months.
Results
The study included 28 patients, predominantly male (64.3%), with a mean age of 48 years. Headache was the primary symptom in 92.9% of cases, and positive blood/cerebro spinal fluid cultures were found in 82.14% of cases. All aneurysms were located in the distal circulation, primarily in the anterior circulation system. Glue embolization was successfully performed in all cases, achieving complete aneurysm sac and parent vessel obliteration. Follow-up at 3 months indicated mRS scores of 0 or 1 in 96.5% of cases. Six-month angiographic follow-up showed no aneurysm regrowth or new formations.
Conclusion
Endovascular glue embolization demonstrated high efficacy and safety in treating ruptured IMAs, with a 100% obliteration rate and favorable clinical outcomes in this single-center experience. Despite limitations such as its retrospective design and small sample size, the study supports glue embolization as a viable, less invasive alternative to traditional surgery. Further comparative studies are needed to confirm these findings and refine treatment approaches.

Keyword

Intracranial mycotic aneurysm; Embolization; Outcome assessment

Figure

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  Fig. 1. A patient in their twenties presented with sudden onset headache. (A) Intraventricular hemorrhage observed on computed tomography brain. (B) Angiogram anteroposterior view demonstrates mycotic aneurysm located in the posterior choroidal branch of left posterior cerebral artery. (C) Lateral view of the aneurysm depicted in 3-dimensional reconstruction (arrow). (D) Catheter positioned in the aneurysm sac, with embolization and parent vessel occlusion using 20% glue. (E) Complete obliteration of the aneurysm is evident on post procedure angiogram.

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