Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA.
Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA.
J Neurointerv Surg. 2020 Apr;12(4):412-416. doi: 10.1136/neurintsurg-2019-015311. Epub 2019 Oct 9.
Non-trunk basilar artery perforator aneurysms (BAPAs) are rare intracranial vascular pathologies that have long been underdiagnosed, under-reported, and under-analyzed. We performed a systematic review of the efficacy and safety endpoints between conservative and active treatment approaches for non-trunk BAPAs.
Major databases were analyzed for relevant publications between 1995 and 2019. Studies comparing the outcomes between conservative and active treatment approaches such as coiling, stenting, clipping, liquid embolization, and flow diversion were included. Mortality rate, rate of permanent neurological deficit as determined by the modified Rankin Score (mRS), rate of second treatment occurrence, and perioperative complication rate were also assessed.
A total of 24 studies, including 54 patients with 56 non-trunk BAPAs, were included. The mean maximum aneurysm diameter was 2.70 mm (range 1-10). A diagnosis was achieved with the initial DSA in 50.0% (27/54) of the patients. A conservative approach was used in 16 patients while active treatment was used in the other 38. Thirteen of 15 (86.7%) patients in the conservative group and 27/34 (79.4%) in the active treatment group had an mRS score 0-2. A non-significant higher odds of a positive outcome was observed in the conservative group (OR 1.51, 95% CI 0.50 to 4.54). The event-related mortality rate was 3.55% (3/54) with one procedure-related death in the active treatment group.
In patients with non-trunk BAPAs unamenable to active treatment, conservative approaches may result in acceptable functional outcomes and low morbidity. Small sample sizes and under-reporting of outcomes warrant further study.
非主干基底动脉穿支动脉瘤（BAPA）是一种罕见的颅内血管病变，长期以来一直被漏诊、漏报和分析不足。我们对非主干 BAPA 的保守治疗和积极治疗方法的疗效和安全性终点进行了系统评价。
分析了 1995 年至 2019 年期间主要数据库中的相关文献。纳入了比较保守治疗和积极治疗方法（如线圈填塞、支架置入、夹闭、液体栓塞和血流转移）之间结果的研究。还评估了死亡率、改良 Rankin 评分（mRS）确定的永久性神经功能缺损率、二次治疗发生率和围手术期并发症发生率。
共纳入 24 项研究，包括 54 例 56 个非主干 BAPA。平均最大动脉瘤直径为 2.70mm（范围 1-10）。50.0%（27/54）的患者通过初始 DSA 确诊。16 例患者采用保守治疗，38 例患者采用积极治疗。保守组 15 例中的 13 例（86.7%）和积极治疗组 34 例中的 27 例（79.4%）mRS 评分为 0-2。保守组的阳性结局可能性更高，但无统计学意义（OR 1.51，95%CI 0.50 至 4.54）。事件相关死亡率为 3.55%（3/54），其中 1 例发生在积极治疗组。
对于无法进行积极治疗的非主干 BAPA 患者，保守治疗可能会产生可接受的功能结果和较低的发病率。样本量小和结果报告不足需要进一步研究。
