Implantation of left
ventricular assist device (LVAD) is widely performed in patients with end-stage chronic
heart failure.
Infection and
stroke are major complications after LVAD implantation. However, the incidence of
intracranial mycotic aneurysm after LVAD implantation is rare, and with no standard of care. In this study, we describe a case of an
intracranial mycotic aneurysm after LVAD implantation that was successfully treated with trans-arterial embolization (TAE) with N-butyl 2-cyanoacrylate (NBCA) via the brachial artery. A 49-year-old man with a history of implantation of LVAD for ischemic
cardiomyopathy was admitted to our institution. He had infectious
endocarditis and was administered systemic
antibiotics. At 3 weeks after admission,
intracranial mycotic aneurysm of the left posterior parietal artery was detected during a diagnostic examination for asymptomatic
intracranial hemorrhage.
Anticoagulant therapy was administered to prevent thromboembolic complications of LVAD implantation. Under
local anesthesia, TAE with NBCA was performed via the brachial artery because of the tortuous anatomy of the origin of the innominate artery and implant of the aortic arch. The
aneurysm was completely obliterated. The patient was discharged without neurological deficits. TAE using NBCA could be an effective modality for the treatment of
intracranial mycotic aneurysm after LVAD implantation.