Intracranial Mycotic Aneurysm after Left Ventricular Assist Device Implantation Treated with Trans-arterial Embolization via the Brachial Artery: A Case Report.

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.

Systemic inflammatory response associated with augmentation and activation of leukocytes in Candida/indomethacin administered mice.

We have previously shown that the combination of beta-glucan and nonsteroidal anti-inflammatory drugs (NSAIDs) was lethal to mice. In this study, we examined the effect of Candida on this treatment and found that Candida showed similar lethal toxicity when used in combination with indomethacin. It was also confirmed that LPS preparations from various origins and by various procedures did not show lethality. Candida/indomethacin induced lethality was found to be associated with increased number of leukocytes in various organs and activation of these cells. These findings strongly suggest that pathogenic fungi augment the side effects of non-steroidal anti-inflammatory drugs.