Fenestration Of Intracranial Artery Research Articles

Endovascular Management of Complex Fenestration-Associated Aneurysms: A Single-Institution Retrospective Study and Review of Existing Techniques

Aneurysms associated with fenestrations of intracranial arteries are exceptionally rare findings. Management strategies for these aneurysms are not well-defined, especially regarding endovascular treatment. We sought to investigate the strategies and feasibility of endovascular treatment approaches for various fenestration-associated intracranial aneurysms. We performed a retrospective chart review of 2000 aneurysms treated endovascularly, identifying 8 aneurysms located at arterial fenestrations. The technical details and procedural outcomes were reviewed to identify common management approaches, technical nuances, and treatment outcomes. There were 3 (37.5%) aneurysms associated with fenestrations of the basilar artery or vertebrobasilar junction. All 3 were successfully treated with a previously undescribed coil-assisted flow-diversion technique, resulting in complete obliteration. Three (37.5%) aneurysms were associated with fenestrations of the anterior communicating artery. Of those, 2 were successfully treated with stent-assisted coil embolization and 1 with coil embolization alone. One (12.5%) aneurysm was associated with a fenestration of the paraclinoid internal carotid artery and 1 (12.5%) aneurysm found was at the takeoff of the posterior inferior cerebellar artery at a fenestration of the vertebral artery. Both were successfully treated with coil-assisted flow diversion. There were no permanent procedural complications. Major considerations for endovascular management of these aneurysms were the dominance of fenestration trunks, aneurysms arising from the fenestration apex or a fenestration limb, amenability to flow diversion, and anticipation of vascular remodeling. Fenestration-associated aneurysms are very rare. We have identified common factors to help guide decision-making for endovascular approaches and demonstrate successful aneurysm treatment using these methods.

Nonaneurysmal cerebrovascular conditions associated with intracranial arterial fenestrations

Background: Cerebral arteries have been identified with multiple anatomical variations, including a concomitant fenestration with aneurysms, but no association is proven. Aim: to investigate non aneurysmal disorders associated with intracranial arterial fenestration. Methods: A thorough and detailed analysis of the available literature from 1970 to 2020 in PubMed were contemplated to identify and address all the disorders associated with arterial fenestration with exclusion of intracranial aneurysms. Results: While segmental vulnerability may induce invisible anatomical histological and hemodynamic changes, cadaveric studies showed that the frequency of fenestration is up to 40% higher than the clinical reports, and the cadaveric reports also showed a higher occurrence of such fenestrations as compared to radiological studies. The vertebrobasilar system, the most common site of fenestration. Fused vertebrae and other vascular defects of up to 7% are previously associated with the vertebral artery fenestration. Conclusion: intracranial fenestration is a critical anatomical variant. Thus, A comprehensive angiographical examination can enhance overall prognosis in presurgical planning in association with other vascular abnormalities.

Fenestrations of intracranial arteries.

Few data are available on the frequency and location distribution of fenestrations of intracranial arteries. We used 3D rotational angiography of all intracranial arteries in a cohort of 179 patients with suspected intracranial aneurysms to assess the prevalence and location of fenestrations and the relation of fenestrations to aneurysms. Of 179 patients with subarachnoid hemorrhage admitted between March 2013 and June 2014, 140 had 3D rotational angiography of all cerebral vessels. The presence and location of aneurysms and fenestrations were assessed. In patients with both aneurysms and fenestrations, we classified the relation of the location of the aneurysm as remote from the fenestration or on the fenestration. In 140 patients, 210 aneurysms were present. In 33 of 140 patients (24%; 95% confidence interval, 17.2%-31.3%), 45 fenestrations were detected with the following locations: anterior communicating artery in 31 (69%), A1 segment of the anterior cerebral artery in 4 (9%), middle cerebral artery in 4 (9%), basilar artery in 4 (9%), vertebral artery in 1 (2%), and anterior inferior cerebellar artery in 1 (2%). Of 56 patients with anterior communicating artery aneurysms, 14 had a fenestration on the anterior communicating artery complex. The remaining 31 fenestrations had no anatomic relation to aneurysms. In 140 patients with 210 aneurysms, 14 aneurysms (7%) were located on a fenestration and 196 were not. In patients with a suspected ruptured aneurysm, fenestrations of intracranial arteries were detected in 24% (33 of 140). Most fenestrations were located on the anterior communicating artery. Of 45 fenestrations, 14 (31%) were related to an aneurysm.

Arterial fenestrations and their association with cerebral aneurysms

Fenestrations of intracranial arteries and associated aneurysms are rare. The significance of these fenestrations in relation to aneurysms remains unclear. We present four patients with fenestration-associated aneurysms and a comprehensive review of associations with aneurysms and other vascular lesions. A PubMed search of the literature was conducted from 1970–2012 reporting cases of intracranial aneurysms associated with arterial fenestration or duplications. Data were collected on patient presentation, sex, age, aneurysm and fenestration location, aneurysm treatment, and presence of other vascular lesions. We performed a retrospective review of four patients with intracranial fenestrations associated with aneurysms at our institution from 2012–2013. There were 59 cases of fenestrations and associated aneurysms in the literature. Aneurysms were reported as either arising from (n=50) or adjacent to but distinct from (n=13) fenestrations. The most common single fenestration location was at the basilar artery (n=23, 36.5%); however the majority of fenestrations were in the carotid circulation (n=34, 54.0%). The majority of patients with aneurysms and fenestrations at all locations except those at the anterior communicating artery (70.5%) presented with subarachnoid hemorrhage. Patients with aneurysms arising from a fenestration or adjacent to a fenestration presented with an additional intracranial vascular lesion in 38% and 31% of cases, respectively. The majority of all aneurysms were treated with microsurgical clipping. Aneurysms associated with cerebral arterial fenestrations are most commonly discovered after subarachnoid hemorrhage and are most often located in the carotid circulation. A high index of suspicion must be maintained for an associated vascular lesion if an intracranial fenestration is discovered.

Intracranial Arterial Fenestrations Associated with Arteriovenous Malformations Diagnosed by CT Angiography

Fenestrations involving aneurysms have been well documented. Only sporadic papers have been reported on fenestrations associated with AVMs (arteriovenous malformations) with few cases. Our study is to determine the rate of co-occurrence of fenestrations and AVMs and to analyze the possible relationship between them by CTA. Between January 2006 and February 2012, the CTA data of 5,657 consecutive patients were retrospectively reviewed. A total of 12 cases (.21%) of fenestrations associated with AVMs were found. Of these, single-fenestrations were identified in 9 cases, and multifenestrations were found in 3 cases. Among 349 fenestrations, there were 15 cases of multifenestrations. The frequency of multifenestrations among fenestrated patients without AVMs was 3.6%. There was no significant difference in the incidence of AVMs in cases with and without fenestrations (3.4% and 2.7%), and there was no significant difference in the incidence of fenestration in cases with and without AVMs (7.7% and 6.1%, χ(2) = .643, P = .423). CTA may play a vital role in assessing the anomalies of co-occurring AVM and fenestration, with an incidence of .21%. The frequency of multifenestrations in fenestrated cases with AVMs was higher than those without AVMs, though there is no significant association between fenestrations and AVMs.

Cerebral arterial fenestrations: a common phenomenon in unexplained subarachnoid haemorrhage

Fenestrations of intracranial arteries are variants resulting from incomplete fusion of vessels during development with unknown clinical significance. They are best visualised with 3D rotational angiography (3DRA). In a prospective consecutive series of patients with suspected aneurysms, 3DRA was performed to identify not only the potential bleeding source but also to assess the frequency and location of any fenestrations of intracranial arteries. In 287 consecutive patients with possible intracranial aneurysms (accidental discovery or previous history of SAH), 3DRAs were prospectively performed, and the location of subarachnoid haemorrhage was assessed by CT. Of 174 patients presenting with SAH, 153 had saccular aneurysms, and in 21 cases (12.1%), no source of bleeding was found. In 20 of these 21 patients with "unexplained SAH" (95.2%) an arterial fenestration was detected in the neighbourhood of the clot. The incidence of fenestration in the 153 aneurysmal SAH patients was 22.9%, and it was 23.3% in 266 patients with intracranial aneurysms (113 accidental and 153 ruptured). Arterial fenestration was detected in 22.9% of ruptured cerebral aneurysms, in contrast with 95.2% in patients with unexplained SAH, the difference being statisctically significant (p < 0.01). Fenestration is a developmental defect, a structural wall weakness possibly making the vessel prone to rupture. Its incidence of nearly 100% may suggest a connection with idiopathic SAH. The presented data indicate that arterial fenestrations are generally overlooked, and they can be considered as one of the candidates for the source of idiopathic SAH.

Magnetic Resonance Angiography and CT Angiography of Persistent Primitive Olfactory Artery: Incidence and Association Rate with Aneurysm in Korea

Copyrights © 2012 The Korean Society of Radiology Purpose: Japanese data indicates an incidence of persistent primitive olfactory artery (PPOA) of 0.14%. We studied the incidence of PPOA and associated cerebral vascular variation or anomalies in Korea. Materials and Methods: We retrospectively reviewed cranial magnetic resonance angiography (MRA) and computed tomography angiography (CTA) images of a total of 9841 patients of our institution. The diagnostic criterion of PPOA is extreme anterioinferior course of the proximal anterior cerebral artery, with a hairpin turn of the lateral projection. Results: We found 29 cases (0.29%) with PPOA. The PPOA location was on the left in 19 cases, bilateral in 3 cases, and on the right in 7 cases. An aneurysm was found at the hairpin turn in 2 patients. There were aneurysms in other sites in 3 cases. There were hypoplasia of anterior cerebral artery in 3 cases, and fenestration of intracranial artery in 1 case. Conclusion: In Korean populations, the incidence of PPOA found in MRA and CTA was twice as high as that shown in the previous Japanese data. Within Korea, left side laterality is more common than right side or bilalterality. Aneurysmal dilatations at the hairpin turning point and aneurysms at other sites were found, and other vascular variations were observed in several cases. Index terms Persistent Primitive Olfactory Artery Aneurysm Angiography Magnetic Resonance Angiography and CT Angiography of Persistent Primitive Olfactory Artery: Incidence and Association Rate with Aneurysm in Korea 잔류 원시 후각동맥의 자기공명 및 전산화단층촬영 혈관조영술 소견: 한국인에서의 빈도와 동맥류와의 연관성

The frequency of intracranial arterial fenestrations: A study with 64-detector CT-angiography

Fenestration is a vascular variation that begins with a common origin, then splits into two parallel luminal channels and rejoins distally. Potential association between anomalies of cerebral circulation and increased occurrence of aneurysm makes intracranial arterial fenestrations important. The planning of intracranial arterial interventions may be complicated if a fenestration occurs proximal to the site of intended treatment. This study is planned to determine the frequency of fenestrations on CT angiography and to search whether there is relationship between aneurysms and fenestrations. CT angiographies of 395 consecutive patients, performed by 64-detector CT, were retrospectively reviewed for aneurysms and fenestrations. Overall fenestration frequency, fenestration frequency in patients with and without aneurysm, and aneurysm frequency in patients with and without fenestration were searched. Demographic characteristics of patients were also compared. Overall fenestration frequency was 12.9%. Vertebrobasilar system (5.56%) and anterior communicating region (5.32%) were the two most frequent sites of fenestration. The rate of fenestrations was not significantly different between patients who had and did not have aneurysms. Mean age was significantly higher, and females were predominant in patients with aneurysms. However our results did not show significant difference in age and sex of patients with fenestrations. The frequency of fenestrations in this study is higher than in previously published radiological studies, suggesting that fenestrations are relatively common. There is no significant relationship between the frequency of aneurysms and fenestrations.

Fenestrations of Intracranial Arteries Detected with 3D Rotational Angiography

Fenestrations of intracranial arteries are variants resulting from incomplete fusion of primitive vessels. An association with aneurysms is suggested in many studies. On conventional angiography, fenestrations are rarely visible. 3D rotational angiography (3DRA) provides improved visualization of cerebral vessels from any desired angle. We used 3DRA to assess the frequency and location of fenestrations of intracranial arteries and a possible relationship with aneurysms. In 208 patients with suspected intracranial aneurysms, 3DRA of 1, 2, or 3 cerebral vessels (in 143, 16, and 49 patients) was reviewed for the presence and location of fenestrations and aneurysms. When fenestrations were present in combination with aneurysms, we noted the relationship of the locations. In 59 of 208 patients, 61 fenestrations were detected (28%). Fenestrations were more frequent in the anterior than in the posterior circulation (23% versus 7%), and the most common location was the anterior communicating artery (AcomA) (43 of 61, 70%). The frequency of fenestrations in 185 patients with aneurysms was not different from the frequency in 23 patients without aneurysms. Of 220 aneurysms present in 208 patients, 10 aneurysms (4.5%) were located on a fenestration. Of 61 fenestrations, 51 (84%) were not associated with an aneurysm. With 3DRA, fenestrations were found in 28% of patients. In our study, fenestrations occurred more often in the anterior than in the posterior circulation, and the most common location was the AcomA. A definite relationship between fenestrations and aneurysms cannot be concluded from our data.

Fenestration of the middle cerebral artery with an associated ruptured aneurysm

Intracranial arterial fenestrations are uncommon developmental anomalies that may alter local hemodynamic stress patterns and may be associated with intracranial aneurysms. A 75-year-old woman presented with a mild subarachnoid hemorrhage. Cerebral angiography demonstrated a 5 mm aneurysm arising from the middle cerebral artery (MCA) associated with a dramatic fenestration of the proximal M1 segment of the MCA. The patient underwent craniotomy with microsurgical aneurysm clipping. The aneurysm arose immediately distal to the fenestration. Several fine perforating arteries were dissected away from the neck of the aneurysm to allow for safe clip placement. Postoperatively, the patient awoke without deficit and was discharged to home on the fifth postoperative day in good condition. Anomalies of the intracranial vasculature are common and we describe a rare proximal MCA fenestration with an associated ruptured aneurysm at the site of the fenestration. Neurosurgeons should be thoroughly familiar with such potential “normal variants” to avoid operative complications that may result from the anomalous circulation in such cases.

Intracranial arterial fenestrations: frequency on CT angiography and association with other vascular lesions

Fenestrations (segmental duplications) of the intracranial arteries are rare anomalies, felt to result from incomplete fusion of primitive embryologic vessels. They have been associated with aneurysms and other vascular lesions. The rate of fenestrations based on published angiographic series has been much lower than that at cadaveric series. The purpose of this study is to determine the frequency of fenestrations and associated vascular lesions at CTA. A total of 504 sequential CTA studies from 2005 to 2006 were retrospectively reviewed for the presence of fenestrations, aneurysms and other vascular lesions. Fenestrations were present in 53 patients (11%). Their frequency was not significantly different in patients referred for aneurysm indications, when compared to those referred for non-aneurysm indications. As expected, there was a much higher frequency of aneurysms in the former group. Associated vascular lesions were relatively uncommon. Aneurysms were present at the fenestration site in three patients, and remote from the fenestration site in eight. One fenestration patient with an associated aneurysm at the fenestration site also had an AVM remote from the fenestration. The frequency of fenestrations in this study was higher than in previously published radiologic studies, suggesting that fenestrations are relatively common, and may be more frequently visualized using cross-sectional imaging. Association with aneurysms and other vascular lesions was relatively uncommon. Our results do not support the theory that fenestrations predispose a patient to aneurysms or vascular malformations remote from the site of the fenestration. Although the association of aneurysms at the site of fenestrations is well documented, our results do not show an overall higher rate of aneurysm formation in patients with fenestrations compared to those without.

Traumatic occlusion of one limb of an intracranial arterial fenestration

Three weeks after an automobile accident, a 35-year-old man experienced left throat and neck pain, numbness of the left face and tongue, dysphagia, left arm pain and weakness, and left miosis. At age 27, he had suffered an aneurysmal subarachnoid hemorrhage. Angiography at that time had also demonstrated a fenestration of the left intracranial vertebral artery. At the time of the second presentation, angiography showed that one of the limbs of the fenestration had become occluded. Although the vast majority of intracranial arterial fenestrations are asymptomatic, occlusion of one of the limbs of a fenestration may be the cause of stroke.