title: Flow diverter stent treatment for ruptured basilar trunk perforator aneurysms.
abstract: OBJECTIVE
  Basilar trunk perforator (BTP) aneurysms are rare. Treatment options traditionally considered for these uncommon lesions have included direct surgery, endovascular therapy, or conservative management. Flow diverters represent a newer therapeutic option for BTP aneurysms but pitfalls and complications are unknown. We describe three patients with BTP aneurysms treated with flow diverter stents.
  
  
  METHODS
  All three patients had ruptured BTP aneurysms and, after loading doses of dual antiplatelet agents, underwent treatment with a flow diverter alone (two patients) or in combination with an intracranial stent (one patient).
  
  
  RESULTS
  Complications directly (two thromboembolic events) or indirectly (one hemorrhage at the external ventricular drain site, probably facilitated by the dual antiplatelet therapy) occurred in all three patients and resulted in permanent morbidity in one case. Imaging follow-up confirmed obliteration in all three patients, and no episodes of rebleeding from the aneurysms were observed at follow-up.
  
  
  CONCLUSIONS
  Flow diverters are effective in obliterating BTP aneurysms. However, given the challenges and complications encountered, especially in patients with ruptured lesions, their use must be carefully weighed against other available therapeutic modalities, including observation.
authors.affiliation: Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Peschillo
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Caporlingua
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: Delia
authors.identifier: http://orcid.org/0000-0002-1611-0840
authors.initials: D
authors.lastname: Cannizzaro
authors.affiliation: Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy.
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Resta
authors.affiliation: Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Burdi
authors.affiliation: Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Valvassori
authors.affiliation: Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Pero
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Aneurysm; Flow Diverter; Hemorrhage; Subarachnoid; Technique