Large saccular aneurysms of the vertebrobasilar arteries with segmental chronic mural ectasia: A case report and review of management strategies.

BACKGROUND: Large saccular aneurysms of the basilar artery associated with chronic mural ectasia are rare and difficult to manage because of their high risk of thrombus formation and rupture. We present a case that highlights the complexities involved in the diagnosis and treatment decision-making of this condition. CASE PRESENTATION: A 54-year-old male with hypertension and ischemic cardiomyopathy presented to the Emergency Department via emergency medical services with confusion and unresponsiveness. Neuroimaging revealed a large basilar artery aneurysm with a mural thrombus and posterior circulation infarcts. Despite conservative management and planned angiography, the patient's condition rapidly deteriorated, and he was declared brain dead within 36 h. DISCUSSION: This case underscores the difficulties associated with managing basilar artery aneurysms, particularly in patients with mural ectasia. It examines the rationale for the initial conservative treatment and evaluates the potential benefits of early endovascular intervention. Literature insights are integrated to explore the implications for vessel integrity, thromboembolic risk, and intervention timing. CONCLUSION: This case highlights the urgent need for standardized guidelines for the management of basilar artery aneurysms. Future research should focus on comparing surgical and endovascular approaches, assessing long-term aneurysm progression, and developing risk-based treatment protocols.