Endovascular Management of Basilar Artery Aneurysms: A Consecutive Series of 124 Patients

<black square> BACKGROUND: Currently, there is no established criterion for determining when interventional treatment is necessary or which strategy is appropriate for basilar artery (BA) aneurysms. Through this study, we aimed to propose an algorithm that can effectively determine the optimal endovascular treatment (EVT) option for BA aneurysms. <black square> METHODS: We enrolled patients with BA aneurysms from June 2016 to December 2022 and performed procedures based on the algorithm. The analysis included demographic, clinical, and aneurysmal characteristics, procedural details, complications, angiographic outcomes, and clinical outcomes. <black square> RESULTS: This study included 124 patients (mean age 55.0 years) with a BA aneurysm who underwent EVT. Of these, 21 aneurysms were treated in the setting of subarachnoid hemorrhage. The majority of the aneurysms were located at the basilar apex (74), followed by the basilar trunk (30) and vertebrobasilar junction (20). Coiling was used in 18.5% of the cases, while stent-assisted coiling embolization was chosen for 58.9%. Overlapping stents were used in 12.9%, flow diverter implantation in 3.2%, Y/T stent techniques in 4.8%, and stent adjunctive coiling with unilateral vertebral artery occlusion in only 1.6%. Procedure-related complications occurred in 15 patients (12.1%). The patients had a modified Rankin Scale score of 0.74 +/- 1.62; 98 (86.7%) had a good prognosis with modified Rankin Scale scores ranging from 0 to 2 at the last followup. Digital subtraction angiography was performed on 105 (84.7%) patients, revealing that 101 (81.5%) achieved complete or near-complete occlusion. <black square> CONCLUSIONS: The criteria for EVT of BA aneurysms based on multi-characteristics were safe and effective. However, further evidence from large cohort studies is needed.