Endovascular electrocoagulation for the treatment of a basilar artery perforator aneurysm not accessible to the microcatheter

Basilar artery perforator aneurysms (BAPAs) are rare and may be occult on initial imaging due to their small size and susceptibility to intermittent thrombosis.1 2 Conventional treatments for aneurysms (eg, clipping or coiling) have proved challenging.3 Recently, endovascular electrocoagulation has been shown to be effective for BAPAs.1 4 5 Here, we report a case of a ruptured BAPA not accessible to a microcatheter, which was successfully treated by endovascular electrocoagulation (video 1). During endovascular electrocoagulation, the tip of the microguidewire functions as an anode, facilitating thrombosis in the aneurysm or parent artery by attracting negatively charged blood particles after passage of an electric current.4 Postoperative immediate angiography showed that the aneurysm completely disappeared. Digital subtraction angiography was repeated 10 days later and showed no recurrence of the aneurysm. This case demonstrates that endovascular electrocoagulation can serve as a promising alternative to conventional endovascular techniques in selected cases if a microcatheter cannot be advanced into the aneurysm sac.neurintsurg;jnis-2024-022857v1/V1F1V1Video 1Technical video demonstrating endovascular electrocoagulation for the treatment of a basilar artery perforator aneurysm not accessible to the microcatheter.