Management and long-term follow-up of basilar trunk artery aneurysms: a single center experience

Basilar trunk artery (BTA) aneurysm is a serious disease, management of which remains controversial and challenging. We conducted a single-center retrospective cohort study of 67 patients with 72 BTA aneurysms diagnosed and treated at our institution. Finally, 39 participants underwent conservative treatment and 27 received endovascular surgical treatment, including one patient who underwent external carotid artery-radial artery-second segment of the posterior cerebral artery bypass. Data on patient clinical and aneurysm characteristics were collected and risk factors for unfavorable outcome and death analyzed. 33 patients presented with subarachnoid hemorrhage and 15 had a poor Hunt-Hess grade. Mean aneurysm diameter was 14.8 ± 12.6 mm and 28 aneurysms were > 15 mm. The total proportions of favorable outcome and mortality at discharge were 64.2% and 17.9%, respectively, while the corresponding proportions in the surgery groups were 53.6% and 17.9%. Moreover, we conducted long-term follow-up from initial diagnosis to 3 years. 57 patients had ≥ 6 months of follow-up and 31 patients reached 3 years. Mean follow-up time was 23.23 ± 21.58 months. The proportions of patients with unfavorable outcome and death increased in the group undergoing conservative treatment during the 3-year follow-up period. Further, the natural rupture rate increased from 43.3% initial diagnosis to 81.8% at 3 years. Poor Hunt-Hess grade was an important risk factor for unfavorable outcome and death. Undergoing surgery was a protective factor against death at six months; however, the complications rate was higher in the surgery group than that in patients receiving conservative treatment. In conclusion, although BTA aneurysm management remains controversial and unsatisfactory, patients with BTA aneurysm in the surgical intervention group appeared to have better outcomes.