Successful Nonsurgical Treatment of Unruptured Basilar Artery Dissecting Aneurysm Complicated by Ischemic Stroke: A Case Report and Literature Review.

The purpose of this case report is to describe the clinical presentation and successful management of an isolated basilar artery dissecting aneurysms (BADAs), highlighting the challenges in decision-making and the outcomes of nonsurgical treatment. A 60-year-old man presented with vertigo, vomiting, slurred speech, and hearing loss on one side. Imaging revealed a BADA with a mural thrombus, compressing the brainstem. His condition quickly worsened, resulting in left-sided hemiplegia, dysphagia, and ataxia. Despite anticoagulant treatment, follow-up imaging showed new strokes. Surgical intervention in BADAs carries high risks, including morbidity and mortality. For unruptured aneurysms causing brainstem compression, endovascular treatment is often preferred. Aspirin is recommended for patients with cerebral ischemia, while patients without ischemia or hemorrhage are generally monitored without antithrombotic therapy. The timing of intervention for asymptomatic cervical artery dissection aneurysms remains unclear, and treatment decisions should be made on a case-by-case basis. In this case, the patient received nonsurgical treatment, which successfully controlled the infarction without aneurysm rupture or hemorrhage. However, individualized treatment decisions remain essential.