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Basilar Artery Fenestration Aneurysms: Endovascular Treatment Strategies Based on 3D Morphology

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Abstract

Purpose

Basilar artery is the second most common site of fenestration, after the anterior communicating region. It is believed this variation predisposes a patient to posterior aneurysm formation and increases the complexity of the surgical anatomy. Endovascular management has become the first option to treat these aneurysms. We retrospectively evaluated eight patients, who underwent endovascular treatment for fenestrated basilar artery related aneurysms (fBA-AN). Additionally, based on our findings and on literature review, we developed a treatment strategy based on a proposed classification of fBA-AN.

Methods

Between June 2010 and September 2012, eight patients harboring nine basilar artery fenestration aneurysms were consecutively treated. Based on aneurysm morphology (neck size) and its relationship to the fenestration (sparing or not one channel) characterized by 3D-DSA, we proposed a simple classification and treatment strategies. Additionally, a literature review was performed.

Results

All patients received endovascular treatment. Most aneurysms involved the vertebrobasilar junction and both channels of the fenestration. A total of 5 aneurysms had wide neck while 4 had narrow neck. Overall, 5 (55.5 %) aneurysms were treated with stent assisted coiling, 3 (33.3 %) aneurysms with selective coiling, and 1 (11.1 %) aneurysm with balloon assisted coiling. We had only 1 (11.1 %) complication, named aneurysm rupture.

Conclusion

Basilar artery fenestration aneurysms are rare and complex lesions. Endovascular treatment appears to be safe and efficient. The detailed understanding of the aneurysm morphology and its relation to the fenestration is strongly recommended to treatment planning. Further studies are necessary to validate the utility of the proposed classification and treatment strategy.

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References

  1. Gao LY, Guo X, Zhou JJ, Zhang Q, Fu J, Chen WJ, Yang YJ. Basilar artery fenestration detected with CT angiography. Eur Radiol. 2013;23(10):2861–7.

    Article  PubMed  Google Scholar 

  2. Tanaka M, Kikuchi Y, Ouchi T. Neuroradiological analysis of 23 cases of basilar artery fenestration based on 2280 cases of MR angiographies. Interventional Neuroradiol. 2006; 12(Suppl 1):39–44.

    CAS  Google Scholar 

  3. Tanaka S, Tokimura H, Makiuchi T, Nagayama T, Takasaki K, Tomosugi T, Hirahara K, Yamahata H, Campos F, Nishizawa T, Arita K. Clinical presentation and treatment of aneurysms associated with basilar artery fenestration. J Clin Neurosci. 2012;19(3):394–401.

    Article  PubMed  Google Scholar 

  4. Saatci I, Cekirge HS, Karcaaltincaba M, Basgun N, Berker M, Timurkaynak E, Ozcan OE. Endovascular treatment of kissing aneurysms at the fenestrated basilar artery: case report with literature review. Surg Neurol. 2002;58:54–8.

    Article  CAS  PubMed  Google Scholar 

  5. Yoon SM, Chun YI, Kwun BD. Vertebrobasilar junction aneurysms associated with fenestration: experience of five cases treated with Guglielmi detachable coils. Surg Neurol. 2004;61:248–54.

    Article  PubMed  Google Scholar 

  6. Nagashima H, Okudera H, Orz Y, Kobayashi S, Nakagawa F. Endovascular treatment of basilar trunk aneurysm associated with fenestration of the basilar artery. Neurosurg Rev. 1999;22:219–21.

    Article  CAS  PubMed  Google Scholar 

  7. Islak C, Naci K, Kantarci F, Saatci I, Uzma O, Canbaz Bulent. Endovascular management of basilar artery aneurysms associated with fenestrations. AJNR Am J Neuroradiol. 2002;23:958–64.

    PubMed  Google Scholar 

  8. Pierot L, Boulin A, Castaings L, Rey A, Moret J. Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery. 1996;38(5):948–54.

    Article  CAS  PubMed  Google Scholar 

  9. Nichols DA, Brown RD, Thielen KR, Meyer FB, Atkinson JLD, Piepgras DG. Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg. 1997;87:374–80.

    Article  CAS  PubMed  Google Scholar 

  10. Graves VB, Strother CM, Weir B, Duff TA. Vertebrobasilar junction aneurysms associated with fenestration: treatment with Guglielmi detachable coils. AJNR Am J Neuroradiol. 1996;17:35–40.

    CAS  PubMed  Google Scholar 

  11. Kai Y, Hamada J, Morioka M, Yano S, Fujioka S, Kuratsu J. Endovascular treatment of ruptured aneurysms associated with fenestrated basilar artery – two case reports. Neurol Med Chir. (Tokyo) 2006;46:244–7.

    Article  Google Scholar 

  12. Peluso JPP, van Rooij WJ, Sluzewski M, Beute GN. Aneurysms of the vertebrobasilar junction: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol. 2007;28:1747–51.

    Article  CAS  PubMed  Google Scholar 

  13. Albanese E, Russo A, Ulm AJ. Fenestrated vertebrobasilar junction aneurysm: diagnostic and therapeutic considerations. J Neurosurg. 2009;110:525–9.

    Article  PubMed  Google Scholar 

  14. Tasker AD, Byrne JV. Basilar artery fenestration in association with aneurysms of the posterior cerebral circulation. Neuroradiology. 1997;39:185–9.

    Article  CAS  PubMed  Google Scholar 

  15. Juszkat R, Nowak S, Moskal J, Kociemba W, Zarzecka A. Endovascular treatment of basilar artery aneurysms associated with distal fenestration – a case report. Interventional Neuroradiol. 2009;15:109–11.

    CAS  Google Scholar 

  16. Foroni LHL, Figueiredo EG, Teixeira MJ, Caldas JGMP, Leszczynski A, Rivau FR. Saccular aneurysms at middle basilar trunk fenestration. Arq Neuropsiquiatr. 2010;68(2):309–11.

    Article  PubMed  Google Scholar 

  17. Chung J, Park H, Lim YC, Hyun DK, Shin YS. Endovascular treatment of basilar artery trunk aneurysms. Acta Neurochir. 2011;153:2137–45.

    Article  PubMed  Google Scholar 

  18. Gruber TJ, Ogilvy CS, Hauck EF, Levy EI, Hopkins LN, Siddiqui AH. Endovascular treatment of a large aneurysm arising from a basilar trunk fenestration using the waffle-cone technique. Neurosurgery. 2010;67(3 Suppl Operative):ons140–44.

    PubMed  Google Scholar 

  19. Alurkar A, Karanam LSP, Oak S. Endovascular treatment of ruptured saccular aneurysm from basilar artery fenestration. Neurol India. 2012;60:682–3.

    Article  PubMed  Google Scholar 

  20. Im SH, Kwon BJ, Jung C, Seo HS, Lee DH, Han MH. Coil embolization of “kissing aneurysms” associated with distal basilar artery fenestration. Clin Neurol Neurosurg. 2007;109(2):210–3.

    Article  PubMed  Google Scholar 

  21. Kan P, Abla AA, Dumont TM, Snyder KV, Hopkins LN, Levy EI, Siddiqui AH. Double-barrel stent-assisted coiling of a basilar artery fenestration aneurysm. J Neuroimaging. 2013;23:496–9.

    Article  PubMed  Google Scholar 

  22. Fujimoto K, Kawai S, Yonezawa T, Masui K, Nishi N, Maekawa M, Uranishi R. Basilar trunk aneurysms with associated fenestration treated by using Guglielmi detachable coils: two cases reports. J Stroke Cerebrovasc Dis. 2007;16(2):84–7.

    Article  PubMed  Google Scholar 

  23. Stark MM, Skeik N, Almandoz JED, Crandall BM, Tubman DE. Concurrent basilar artery diuble fenestration with aneurysm and vertebral artery dissection: case report and literature review of rare cerebrovascular abnormalities. Ann Vasc Surg. 2013;27(4):497.e15–21.

    Article  PubMed  Google Scholar 

  24. Krings T, Baccin CE, Alvarez H, Ozanne A, Stracke P, Lasjaunias PL. Segmental unfused basilar artery with kissing aneurysms: report of three cases and literature review. Acta Neurochir (Wien). 2007;149:567–74.

    Article  CAS  Google Scholar 

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Acknowledgments

We gratefully acknowledge Janaína Rezende for an invaluable assistance in preparing the drawings.

Financial Support and Industry Affiliations:

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Instituto Neurovascular, Rua Timbiras 3616, 30140-062, Belo Horizonte, Minas Gerais, Brazil

    F.P. Trivelato MD, A.C. Ulhôa MD, L.B. Manzato MD & M.T.S. Rezende MD

  2. Division of Interventional Neuroradiology, Department of Internal Medicine, Medical School of Ribeirão Preto,University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil

    D.G. Abud PhD, G.S. Nakiri MD & L.H. de Castro Afonso MD

Authors
  1. F.P. Trivelato MD
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  2. D.G. Abud PhD
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  3. G.S. Nakiri MD
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  4. L.H. de Castro Afonso MD
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  5. A.C. Ulhôa MD
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  6. L.B. Manzato MD
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  7. M.T.S. Rezende MD
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Correspondence to F.P. Trivelato MD.

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Trivelato, F., Abud, D., Nakiri, G. et al. Basilar Artery Fenestration Aneurysms: Endovascular Treatment Strategies Based on 3D Morphology. Clin Neuroradiol 26, 73–79 (2016). https://doi.org/10.1007/s00062-014-0336-0

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  • DOI: https://doi.org/10.1007/s00062-014-0336-0

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