BACKGROUND AND PURPOSE: Patients with infective endocarditis may develop intracranial mycotic aneurysms. Whether these patients should undergo cerebral angiography followed by prophylactic surgery if an aneurysm is detected is an unresolved question. METHODS: We estimated the probability of survival 12 weeks after the diagnosis of infective endocarditis on the basis of data available in the literature. RESULTS: For a 40-year-old female patient with right-sided hemiplegia, the 12-week survival is estimated to be 83.75% without angiography and 83.65% with angiography; the specific mortality of intracranial mycotic aneurysms is relatively small but increases by 40% (from 0.25% to 0.35%) if angiography is performed. The risk of aneurysm rupture in infective endocarditis and the mortality from rupture appear to be the most important factors that affect the analysis. CONCLUSIONS: Cerebral angiography should not be performed routinely in patients with infective endocarditis. Specific subgroups in whom such a policy might be beneficial have not yet been identified.
BACKGROUND AND PURPOSE:Patients with infective endocarditis may develop intracranial mycotic aneurysms. Whether these patients should undergo cerebral angiography followed by prophylactic surgery if an aneurysm is detected is an unresolved question. METHODS: We estimated the probability of survival 12 weeks after the diagnosis of infective endocarditis on the basis of data available in the literature. RESULTS: For a 40-year-old female patient with right-sided hemiplegia, the 12-week survival is estimated to be 83.75% without angiography and 83.65% with angiography; the specific mortality of intracranial mycotic aneurysms is relatively small but increases by 40% (from 0.25% to 0.35%) if angiography is performed. The risk of aneurysm rupture in infective endocarditis and the mortality from rupture appear to be the most important factors that affect the analysis. CONCLUSIONS: Cerebral angiography should not be performed routinely in patients with infective endocarditis. Specific subgroups in whom such a policy might be beneficial have not yet been identified.
Authors: L M Allen; A M Fowler; C Walker; C P Derdeyn; B V Nguyen; A N Hasso; B V Ghodke; G J Zipfel; D T Cross; C J Moran Journal: AJNR Am J Neuroradiol Date: 2012-10-11 Impact factor: 3.825