Differentiating aetiologies in perimesencephalic SAH: clinical insights into basilar artery perforator aneurysms.
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Rajbhandari Saujanya, Serrallach Bettina Lara, Raabe Johann Maximilian, Piechowiak Eike I, Goldberg Johannes, Seiffge David J, Rentzos Alexandros, Zhu François, Scarcia Luca, Narata Ana, Amans Matthew R, Premat Kevin, Demerath Theo, Moehlenbruch M, Kumar Rahul, Limbucci Nicola, Piano Mariangela, Burel Julien, Bellanger Guillaume, Dorn Franziska, Hennersdorf Florian, Stracke Paul, Milonia Luca, Cirillo Luigi, Wasselius Johan, Lenthall Rob, Flynn Liam, Keston Peter, Raz Eytan, Barvulsky Enrique, Giubbolini Francesca, Leonard-Lorant Ian, Smajda Stanislas, Klisch Joachim, Kaiser Daniel P O, Rizzuti Michele, Tanaka Michihiro, Kizilkilic Osman, Booth Thomas C, Linfante Italo, Leber Stefan L, Hassan Farouk, Dumas Victor, Forestier Géraud, Li Yan, Alexandre Andrea, Padilla-Palomo Francisco Javier, Karwacki Grzegorz M, Saleem Nayyar, Abdalkader Mohamad, Herial Nabeel A, Pulli Benjamin, Tran Chi Cuong, Raabe Andreas, Gralla Jan, Bervini David, Z'Graggen Werner Josef, Kaesmacher Johannes, Dobrocky Tomas, PERFAN registry (PERforator ANeurysm registry) collaborators
Аннотация
METHODS: This retrospective, multicentre, observational cohort study included BAPA cases from the international PERForator Aneurysm registry (2013-2025, 60 centres, 19 countries). Comparison cohorts were from a single high-volume tertiary care centre (2004-2025). The study included 444 patients (n=167 NAA, n=157 BAPA, n=120 r-pc-AN). Excellent outcome was defined as a modified Rankin Scale score of 0-1 at 3-6 months.
RESULTS: Excellent outcomes were achieved in 137/167 (82%) of NAA, 96/140 (69%) of BAPA and 56/102 (55%) of r-pc-AN cohorts (p<0.001). Mortality rates were 1% (NAA), 11% (BAPA) and 18% (r-pc-AN). cCompared with BAPA, NAA patients had significantly higher odds of excellent outcome (adjusted OR, aOR 2.0, 95% CI 1.2 to 3.4, p=0.01), while r-pc-AN were associated with significantly lower odds of excellent outcome (aOR 0.5, 95% CI 0.3 to 0.9, p=0.01). Hydrocephalus and external ventricular drain rates were highest in r-pc-AN (83% and 87%), followed by BAPA (48% and 44%) and NAA (28% and 16%) (p<0.001).
CONCLUSIONS: While pmSAH has been considered benign, our findings challenge this assumption. Patients with BAPA-related pmSAH demonstrated significantly worse outcomes than NAA but better outcomes than r-pc-AN. Further research is needed to distinguish BAPA-pmSAH from NAA-related pmSAH and to establish diagnostic and therapeutic guidelines.
TRIAL REGISTRATION NUMBER: NCT06189014.