Abstract Details

Title Neurological outcomes of patients with mycotic aneurysms in infective endocarditis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-059

Objective To evaluate the outcomes of mycotic aneurysms (MAs) in a contemporary case series of infective endocarditis.

Background The natural history and outcomes of MAs under contemporary medical therapy has been less well characterized. We hypothesized that the rupture rate of MAs would be lower than historical case series.

Design/Methods Retrospective chart review was performed at two US academic medical centers of patients ≥ 18 years with infective endocarditis and MAs. Information was collected regarding risk factors, imaging, treatments, and outcomes. Outcomes of interest included ischemic stroke, intracerebral hemorrhage (ICH), MA size, and in-hospital mortality.

Results We identified 22 patients (mean age 54, 10 female) with infective endocarditis and MAs. Eighteen patients had positive cultures, 1 of whom had fungal endocarditis and the rest bacterial. Patients averaged 1.4 MAs, and average maximum diameter was 4.5 mm (range 1.2-15.0 mm). Among the 22 patients, 12 had ≥ 1 ruptured MAs, 13 had infarction on imaging, 18 had ICH, and 3 were asymptomatic. No MAs ruptured after aneurysm discovery. Of 12 patients with ruptured MAs, 9 were secured neurosurgically or endovascularly and 3 received antibiotics alone. Of 10 patients with unruptured MAs, 7 received antibiotics alone. Of 10 patients on antibiotics only, 5 underwent repeat imaging of which 1 had enlarging MA; 1 died in hospital. Of 12 patients with secured MAs, 2 died in hospital. Eight unsecured patients underwent CTS and 3 secured patients underwent CTS. One unsecured patient suffered a symptomatic ischemic stroke after CTS, while no others suffered perioperative neurological events including ICH. One unsecured patient after CTS died in hospital, while no secured patients after CTS died in hospital.

Conclusions Treatment with antibiotics alone in MA may have similar outcomes to treatment with neurosurgical or endovascular therapy. Further investigation is warranted to determine the risk of undergoing CTS in unsecured MAs.

Authors/Disclosures
Hang Shi, MD PRESENTER	Dr. Shi has nothing to disclose.
	No disclosure on file
	No disclosure on file
Neal S. Parikh, MD (Alnylam Pharmaceuticals)	Dr. Parikh has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Parikh has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for cases of neurological illness. Dr. Parikh has stock in Alnylam Pharmaceuticals. The institution of Dr. Parikh has received research support from Leon Levy Foundation. The institution of Dr. Parikh has received research support from Florence Gould Foundation. The institution of Dr. Parikh has received research support from NY State Empire Clinical Research Investigator Program. The institution of Dr. Parikh has received research support from NIA. The institution of Dr. Parikh has received research support from Medtronic.
Jose Gutierrez, MD (Columbia University)	Dr. Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cardiovascular Research Foundation. Dr. Gutierrez has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for White and Rusell. Dr. Gutierrez has received research support from NIH. Dr. Gutierrez has received publishing royalties from a publication relating to health care. Dr. Gutierrez has received publishing royalties from a publication relating to health care.
Joshua Z. Willey, MD, FAAN (Columbia University)	Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edwards Scientific. Dr. Willey has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for RECARDIO. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BrainQ. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Uptodate. The institution of Dr. Willey has received research support from NIH. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Review chapter author, MKSAP 16-20 with American College of Physicians.

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