Abstract
Objective
Preserving a perforating artery incorporated into a basilar tip aneurysm is challenging, particularly in partially thrombosed intracranial aneurysms (PTIAs), and treatment is frequently limited to partial embolization alone.Case presentation
A 53-year-old woman presented with diplopia caused by an 18-mm partially thrombosed basilar tip aneurysm. An artery of Percheron appeared on angiography to arise from the aneurysm wall, and maximum-intensity projection images of DSA confirmed that this single trunk supplied both paramedian thalami. Partial coil embolization was performed to preserve the perforator. During follow-up, the aneurysm enlarged, and the angiographic origin of the perforator appeared to shift toward the neck. This apparent change allowed for safe 2nd-stage stent-assisted coil embolization with preservation of the perforator. The patient remained asymptomatic; at the latest follow-up, she showed only a minor neck recurrence without apparent aneurysm enlargement, and imaging surveillance is ongoing.Conclusion
In a perforator-involving PTIA initially unsuitable for definitive embolization, the angiographic origin of the perforator may appear to shift during follow-up, opening a window for safe staged treatment. This observation derives from a single case only and should be generalized with caution.