Brain-first strategy for infective endocarditis with infectious intracranial aneurysm: Coil embolization followed by endoscopic mitral valve repair

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ID: 328975
2026
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Ranked #102 of 147 articles by views in Interdisciplinary CardioVascular and Thoracic Surgery

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Abstract
Infective endocarditis (IE) complicated by infectious intracranial aneurysms (IIAs) presents a therapeutic dilemma, as cardiopulmonary bypass (CPB) with systemic heparinization may trigger aneurysm rupture, whereas delaying surgery carries the risks of the disease worsening. A 38-year-old man presented with active IE caused by Streptococcus agalactiae with severe mitral regurgitation and a symptomatic 5-mm infectious intracranial aneurysm located in the distal left posterior cerebral artery. Urgent cardiac surgery was required but the aneurysm carried a substantial risk of rupture during CPB, endovascular coil embolization was performed first. Five days later, endoscopic minimally invasive mitral valve repair with an autologous pericardial patch was performed without complications. The patient was discharged after four weeks of antibiotic therapy. At six months postoperatively, the patient remains asymptomatic without recurrent infection or valve dysfunction. A staged strategy consisting of preoperative endovascular treatment followed by minimally invasive valve surgery may represent a safe and effective approach for patients with IE complicated by infectious intracranial aneurysms, allowing cardiac surgery while minimizing the risk of intracranial hemorrhage.
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Authors Shigeru Hattori, Soh Hosoba, Takahiro Fujinawa, Yusuke Gunji
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Journal Interdisciplinary CardioVascular and Thoracic Surgery
Year 2026
DOI
10.1093/icvts/ivag255
URL
https://doi.org/10.1093/icvts/ivag255
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