O-006 Long-term outcomes of medical, endovascular, and microsurgical management of infectious intracranial aneurysms

Abstract

<h3>Background</h3> Infectious intracranial aneurysms (IIAs) or mycotic aneurysms are rare neurological manifestations of infective endocarditis or systemic infections. To date, data on long-term outcomes of IIAs remain limited, and there is no guidelines or standard protocols for management. We explored long-term clinical outcomes in patients treated for IIA using medical, endovascular and microsurgical approaches. <h3>Methods</h3> We retrospectively reviewed patients treated for IIAs at Emory University Hospitals or Grady memorial hospital between May 2015 and May 2020 using diagnosis code and reviewing records of patients with infective endocarditis and concurrent intracranial hemorrhage. Patient charts, imaging data, procedure notes and pathological reports were reviewed including the different treatment approaches including medical, endovascular and microsurgical management. Outcome measures included aneurysm progression or re-rupture, 90-day mRS scores, and mortality. Patients were followed up to 5 years from diagnosis. <h3>Results</h3> Among 1714 patients with infective endocarditis, 322 (19%) developed intracranial hemorrhage of which 17 patients were found to have IIA. In patients with IE, presence of IIA was associated with higher odds of disposition to hospice or death compared to those without IIA (OR = 6.9, p &lt; 0.05). In addition, 7 patients with systemic infections were found to have IIA during the same period. Our cohort included 24 patients with 38 IIAs of which 67% presented with rupture and the remaining were incidental on surveillance imaging. The majority of aneurysms involved the middle cerebral artery (74%), and multiple aneurysms were noted in 30% of subjects. A trial of antibiotics was used 82% of cases whereas primary open or endovascular intervention was used in 18% of patients. Treatment failure defined as progression of aneurysm, rupture or re-rupture was noted in 48% of patients managed medically, and required endovascular or open microsurgical salvage. Treatment failure occurred within 2 weeks of initiation of antibiotics in 50% of cases and independently predicted worse mRS scores and mortality at 90 days. The 2-year survival in this cohort was 70%. <h3>Conclusions</h3> Patients with IIA are at higher risk of neurological decline and mortality in the event of rupture. Patients treated with antibiotics have higher risk of treatment failure requiring salvage surgical or endovascular intervention. Medical treatment failure occurred mostly within 2 weeks of onset and had negative prognostic value emphasizing the need for close follow-up and early surgical or endovascular management if possible. <h3>Disclosures</h3> <b>A. Alawieh:</b> None. <b>L. Dimisko:</b> 1; C; T32NR012715. <b>S. Newman:</b> None. <b>J. Grossberg:</b> None. <b>C. Cawley:</b> None. <b>G. Pradilla:</b> None. <b>O. Samuels:</b> None. <b>D. Barrow:</b> None. <b>B. Howard:</b> None.