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Basilar Artery Perforator Aneurysms: A Single-Center Experience with Conservative Management
Alejandro Venegas1, Keren Zambrano1, Mario Echeverria1
1Department of Diagnostic and Interventional Neuroradiology, Instituto de Neurocirugía Dr. Alfonso Asenjo, Santiago, Chile.
Journal of Neuroendovascular Therapy
|July 30, 2025
Summary
Conservative management of basilar artery perforating aneurysms (BAPAs) led to spontaneous exclusion in 80% of patients, showing favorable outcomes without rebleeding. This approach may be preferred for BAPAs.
Area of Science:
- Vascular Neurology
- Neurosurgery
- Radiology
Background:
- Basilar artery perforating aneurysms (BAPAs) are rare and often present as subarachnoid hemorrhage (SAH).
- Optimal management strategies for BAPAs remain uncertain.
- This study investigates the outcomes of conservative management for BAPAs.
Purpose of the Study:
- To describe the clinical presentation, management, and follow-up of patients with BAPAs.
- To evaluate the efficacy of conservative management for BAPAs.
- To provide insights into the optimal treatment strategy for this rare aneurysm type.
Main Methods:
- Retrospective review of an institutional aneurysm database (January 2008-2024).
- Inclusion criteria: aneurysms located in the middle or upper third of the basilar artery.
- Analysis of clinical presentation, management course, and follow-up data.
Main Results:
- All 11 patients presented with diffuse SAH, 80% showing a perimesencephalic pattern.
- BAPAs were often detected on repeat angiography (approx. 10 days post-initial study).
- Conservative management resulted in spontaneous aneurysm exclusion in 80% of cases, with no rebleeding.
Conclusions:
- Conservative management of BAPAs yielded favorable functional outcomes and a high rate of spontaneous thrombosis.
- This strategy may be effective and preferred, avoiding risks of surgical or endovascular interventions.
- Further research is warranted to confirm these findings for BAPA management.
