Endovascular Treatment for an Infectious Aneurysm Prior to Cardiac Surgery: A Case Report

Masaki Sunaga, Takao Hashimoto, Daichi Kato, Hirofumi Okada, Yujiro Tanaka, Hiroaki Namatame, Nobuyuki Nakajima, Michihiro Kohno
2019 Journal of Neuroendovascular Therapy  
Objective: In patients with infectious endocarditis requiring cardiac surgery, the presence of unruptured infectious intracranial aneurysms is an important issue. We report a patient in whom endovascular treatment for an unruptured infectious intracranial aneurysm was performed prior to cardiac surgery. Case Presentation: A 20-year-old woman was admitted with infectious endocarditis. During the assessment, a cerebellar abscess was noted and drainage was conducted. An infectious intracranial
more » ... us intracranial aneurysm was observed in the posterior cerebral artery and treatment with an antimicrobial drug was continued. Due to severe heart failure, cardiac surgery was required, but there was a slight increase in the aneurysmal size. Intra-aneurysmal embolization was performed while preserving the parent artery. Subsequently, valve plasty was conducted. The patient was discharged. Conclusion: If cardiac surgery is necessary, the treatment of infectious intracranial aneurysms should be performed in advance. If the heart failure is severe, endovascular treatment, which does not influence hemodynamics, may be useful. Keywords▶ infectious intracranial aneurysm, endovascular treatment, cardiac surgery, infectious endocarditis, intra-aneurysmal embolization Case Presentation Patient: A 20-year-old woman. Complaints: Fever and cerebellar ataxia. Medical/Family history: Not contributory. Present illness: Sepsis related to central venous cathetermediated infection occurred during the treatment of fever and liver dysfunction at a previous hospital. Echocardiography showed vegetation in the mitral valve. The patient was referred to the intensive care unit of our hospital due to heart failure related to infectious endocarditis and mitral insufficiency. On admission, the body temperature was 38.0°C and the Japan Coma Scale (JCS) score was I-1.
doi:10.5797/jnet.cr.2018-0022 fatcat:2m5kh2hmbreebakygxllbt7poa