Basilar Tip Asymmetry More Frequent in Aneurysm Patients, but Confounded by Risk Profile

Asymmetrical basilar-tip fusion was more common in aneurysm patients (69.0%) vs clinical reference cohort (44.4%, P=0.01), but exploratory adjusted analyses attenuated the difference. Asymmetry was associated with higher rates of artery of Percheron and PICA variants.

• Retrospective single-center 3D angiography study (2012–2024) comparing basilar apex/SCA aneurysm patients with a non-aneurysm reference cohort.
• In aneurysmal asymmetrical cases, artery of Percheron prevalence was 32.5% vs 5.6% (P=0.04) and PICA-origin asymmetry was 75.0% vs 16.7% (P<0.001).
• Cohort differences were partly explained by demographic and vascular-risk factor differences, limiting causal inference.

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