Cerebral mycotic aneurysms treated with a neuroform stent: technical case report

Abstract

Objective and importance: We describe the first documented endovascular treatment of proximal intracranial mycotic aneurysms by a self-expanding, flexible, dedicated, intracranial Neuroform stent. Treatment with this stent rapidly obliterated the aneurysms, eliminated the need for additional coiling, and maintained the patency of the parent arteries.

Clinical presentation: A 47-year-old male patient with infective endocarditis presented with ischemic stroke and minimal subarachnoid hemorrhage. Cerebral angiography demonstrated a fusiform aneurysm of the supraclinoid segment of the left internal carotid artery and horizontal segment of the left middle cerebral artery, with superimposing side-wall focal aneurysms. Despite antibiotic therapy, the focal aneurysms progressively enlarged, as demonstrated on a subsequent cerebral angiogram at Day 11.

Intervention: A 4-mm x 2-cm Neuroform stent was deployed along the fusiform aneurysm of the left supraclinoid internal carotid artery and the horizontal middle cerebral artery M-1 segment encompassing the focal side-wall aneurysms with preserved patency of the parent arterial segments.

Conclusion: Endovascular stent placement can be an effective treatment for proximal intracranial mycotic aneurysms that fail to respond to medical therapy.