Abstract
Background: Basilar artery fenestration has been proposed as a contributor to ischemic stroke, as unique flow patterns induced by fenestration may be related to thrombus formation or insufficiency. This study aimed to evaluate the hemodynamics of basilar artery fenestration (BAF) using computational fluid dynamics (CFD).Methods: Patients with BAF and normal vertebrobasilar system were recruited and separately evaluated using CFD. Specific geometric vascular models were reconstructed based on 3D-rotational angiography (3D-RA). Patients were divided into the BAF group and control group (i.e., patients with the normal vertebrobasilar system). Hemodynamic and geometric variables were calculated and compared between groups using Student's t-test or Wilcoxon rank-sum test.Results: Overall, 24 patients were included, with 12 patients each in the BAF group and the control group. The BAF group had a significantly smaller basilar artery diameter than the control group (3.1 ± 0.51 vs. 3.76 ± 0.4, p = 0.002). Compared to the control group, the BAF group had higher values of maxOSI (median, 0.3 vs. 0.09, p = 0.028), TAWSSG (median, 983.42 vs. 565.39, p = 0.038) in the flow confluence, higher SAR-TAWSSG in bifurcation (median, 70.22 vs. 27.65, p = 0.002) and higher SAR-TAWSSG in basilar artery (median, 48.75 vs. 16.17, p < 0.001) of the vertebrobasilar artery.Conclusions: This pilot study suggested that hemodynamic differences between BAF and normal vertebrobasilar artery across multiple shear flow parameters. The disturbed flow in the BAF may increase the risk of thrombus formation, plaque instability, and subsequent ischemic cerebrovascular events. These should be confirmed by future studies.
Highlights
Artery fenestration is a rare congenital vascular dysplasia caused by incomplete fusion of primitive embryologic vessels, which are divided into two separate channels and converge at the distal end [1]
The inclusion criteria were as follows: [1] patients diagnosed with Basilar artery fenestration (BAF) by digital subtraction angiography; [2] underwent 3Drotational angiography (3D-RA) and division of the lumen was observed by virtual artery endoscopy; [3] the quality of images was adequate for computational fluid dynamics (CFD) analysis; [4] fenestrations were located in the proximal segment of the basilar artery
No significant differences were found in the baseline characteristics between the two groups, including sex distribution (p = 1), smoking history (p = 1), posterior circulation infarction (p = 0.478), blood pressure, low-density lipoprotein (LDL) (p = 0.27), high-density lipoprotein (HDL) (p = 0.302), fasting glucose (p = 0.22), cholesterol (p = 0.379), and triglyceride (p = 0.818)
Summary
Artery fenestration is a rare congenital vascular dysplasia caused by incomplete fusion of primitive embryologic vessels, which are divided into two separate channels and converge at the distal end [1]. Basilar artery fenestration (BAF) is the second most common form of fenestration with a prevalence of 0.28–5.26% as reported in post-mortem studies [3], 0.3–0.6% in conventional angiography [4], and 1–2.07% in magnetic resonance angiography (MRA) [5–7]. Some cases were related to cerebral infarction and diagnosed as an embolic stroke of undetermined source as these patients usually had no vascular risk factors or other diseases. This suggests that BAF is a possible cause of cryptogenic stroke [1, 2, 13]. Fenestration causes local hemodynamic changes, which may heighten the risk of ischemic stroke or infarction. Basilar artery fenestration has been proposed as a contributor to ischemic stroke, as unique flow patterns induced by fenestration may be related to thrombus formation or insufficiency. This study aimed to evaluate the hemodynamics of basilar artery fenestration (BAF) using computational fluid dynamics (CFD)
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