Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2024; 12(20): 4337-4347
Published online Jul 16, 2024. doi: 10.12998/wjcc.v12.i20.4337
An unusual etiology of subarachnoid hemorrhage, basilar artery perforator aneurysms, in Macao: Three case reports and review of literature
Ieong-Chon Man, Tam-Man Pan, Kuok-Cheong U
Ieong-Chon Man, Tam-Man Pan, Kuok-Cheong U, Department of Radiology, Hospital Conde S. Januário, Macao SAR 999078, China
Author contributions: Man IC conceived and designed the study, collected and analyzed the data, and drafted the manuscript; Pan TM and U KC participated in the analysis and interpretation of the data and critically revised the manuscript for important intellectual content; All authors read and approved the final manuscript.
Informed consent statement: Informed consent of the patient for publication, including personal data and pictures, was given.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kuok-Cheong U, MD, Chief Doctor, Department of Radiology, Hospital Conde S. Januário, Ruoxian Xie Alley, Lobby Area, Macao SAR 999078, China. kuokcu1@gmail.com
Received: March 14, 2024
Revised: May 14, 2024
Accepted: May 27, 2024
Published online: July 16, 2024
Processing time: 108 Days and 15.6 Hours
Abstract
BACKGROUND

Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications. Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage. Conversely, basilar artery perforator aneurysms (BAPAs) are a rare etiology. There is no consensus on the optimal management of ruptured BAPAs in the acute setting.

CASE SUMMARY

We present a case series of 3 patients with ruptured BAPAs who were treated at our institution. Two patients had a modified Fisher grade of I, and one had a grade of IV on initial presentation. The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case. The 3 patients underwent endovascular treatment with Guglielmi detachable coils. Post-treatment, the patients had good clinical outcomes, and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage. However, one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition. The other 2 patients showed progressive recovery, and no aneurysm recurrence was observed at the 2-year follow-up.

CONCLUSION

Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management. Early detection and prompt treatment is important to achieve favorable patient outcomes.

Keywords: Basilar artery; Intracranial aneurysm; Endovascular treatment; Subarachnoid hemorrhage; Case report

Core Tip: Basilar artery perforator aneurysms are a rare cause of subarachnoid hemorrhage. This case series of 3 patients treated with endovascular coiling suggested that this approach may be preferable for managing ruptured basilar artery perforator aneurysms compared with surgical intervention or conservative management. Early detection and prompt treatment are critical. Treatment plans should be individualized based on the patient’s specific circumstances. Further research is needed to establish evidence-based guidelines for the optimal management of this rare condition.