title: Ruptured basilar artery perforator aneurysms--treatment regimen and long-term follow-up in eight cases.
abstract: BACKGROUND
  Basilar artery (BA) perforator aneurysms may lead to severe subarachnoid hemorrhage (SAH). The acute management is uncertain. The anatomic approach is challenging both for coiling and clipping, and flow diverter stenting may be dangerous due to the required antiplatelet therapy. We report on our experiences in eight patients.
  
  
  METHODS
  We retrospectively analyzed eight patients with ruptured BA perforator aneurysm, including clinical characteristics, imaging data, treatment regimen, clinical course, and long-term outcome.
  
  
  RESULTS
  Patients presented with major SAH and World Federation of Neurosurgical Societies (WFNS) scores of I in three, II in two, and V in three cases. In four patients, the aneurysm was detected in the initial angiography, in four only in follow-up angiography. Five patients were treated conservatively and three patients had endovascular therapy. In the conservative group, the aneurysm spontaneously thrombosed in three cases. One patient suffered from a re-SAH and stayed permanently dependent due to an associated perforator stroke (modified Rankin Scale (mRS) 5). The remaining four patients recovered well (mRS 0 and 1 in two cases, each) including three patients also exhibiting perforator strokes. Regarding the endovascular group, one parent vessel was an angioma feeder and embolized with Onyx. The second aneurysm spontaneously thrombosed periinterventionally. The third patient underwent coiling. Two parent vessels were occluded postinterventionally, resulting in perforator strokes. Final mRS scores were 0, 2, and 2, respectively.
  
  
  CONCLUSIONS
  Conservative management of ruptured BA aneurysms might be a first-line treatment option with common spontaneous aneurysm occlusion, low rate of re-SAH, and promising clinical outcome.
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology, Grosshadern Campus, Marchioninistr 15, D-81377, Munich, Germany. robert.forbrig@gmail.com.
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-1054-1463
authors.initials: R
authors.lastname: Forbrig
authors.affiliation: Department of Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Eckert
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology, Grosshadern Campus, Marchioninistr 15, D-81377, Munich, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Ertl
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology, Grosshadern Campus, Marchioninistr 15, D-81377, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Patzig
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology, Grosshadern Campus, Marchioninistr 15, D-81377, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brem
authors.affiliation: Department of Neurology, Grosshadern Campus, University of Munich, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Vollmar
authors.affiliation: Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Röther
authors.affiliation: Department of Neurosurgery, Grosshadern Campus, University of Munich, Munich, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Thon
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology, Grosshadern Campus, Marchioninistr 15, D-81377, Munich, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Brückmann
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology, Grosshadern Campus, Marchioninistr 15, D-81377, Munich, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Fesl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000628:therapy*; D002533:Cerebral Angiography; D003131:Combined Modality Therapy / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics
keywords: Basilar artery; Conservative therapy; Perforator aneurysm; SAH