Ruptured intracranial fungal
mycotic aneurysms have a high mortality rate. It has been reported that the number of
opportunistic infections has increased. Here, we report the first case of a patient in which a ruptured fungal carotid artery
aneurysm was successfully treated by
stent-assisted coil embolization.
Case Description: A 76-year-old male receiving dual antiplatelet
therapy due to a recent percutaneous transluminal angioplasty presented with blurred vision of the right eye and
diplopia. Magnetic resonance imaging revealed a fungal mass in the sphenoid sinus, and the patient was pathologically diagnosed with invasive
aspergillosis. After receiving oral
voriconazole for 4 weeks, he was admitted to the hospital with
hemorrhagic shock from
epistaxis. The right internal carotid artery angiography revealed a de novo irregularly shaped
aneurysm at the cavernous portion, projecting into the sphenoid sinus, which was considered to be the source of
bleeding. Due to the lack of ischemic tolerance and urgent demand for hemostasis, we performed a
stent-assisted coil embolization of the
aneurysm without interrupting the blood flow. Postoperatively, the patient had no neurological deficit, and treatment with
voriconazole was continued for 12 months without rebleeding.
Conclusion:
Stent-assisted coil embolization without parent artery occlusion might be a promising option for the urgent treatment of ruptured fungal
mycotic aneurysms. Long-term administration of
voriconazole might be continued for 12 months for such patients.