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Endovascular Treatment of Fenestration-related Aneurysms

Morphological Features, Operative Techniques and Therapeutic Outcomes

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Abstract

Purpose

Endovascular treatment of fenestration-related aneurysms (FAs) is prone to technical challenges, given the inherent complexities. Herein, we have analyzed FAs in terms of angioarchitectural characteristics and outcomes achieved through endovascular intervention.

Methods

Data accrued prospectively between January 2002 and July 2020 were productive of 105 FAs in 103 patients, each classifiable by the nature of incorporated vasculature as proximal portion, fenestrated limb, or distal end. Our investigation focused on clinical and morphological outcomes, with emphasis on technical aspects of treatment.

Results

The FAs selected for study originated primarily in anterior communicating artery (AcomA: 88/105, 83.8%), followed by basilar (7/105, 6.7%), anterior cerebral (4/105, 3.8%), and internal carotid (3/105, 2.8%) arteries. In nearly all locations, proximally situated aneurysms (43/105, 41%) were more frequent than aneurysms arising at distal ends (3/105, 2.8%), but the majority of AcomA lesions involved fenestrated segments (58/88, 65.9%); and most fenestrated channels (90/105, 85.7%) were asymmetric in size. Orifices of smaller fenestrated limbs were intentionally compromised during coil embolization in 23 aneurysms (21.9%), achieving complete (n = 19) or incomplete (n = 4) compromise, without resultant symptomatic ischemia. Saccular occlusion proved satisfactory in 77 lesions (73.3%). In follow-up monitoring of 100 patients for a mean period of 35.3 ± 26.5 months, 17 instances of recanalization (17.0%) occurred (minor, 9; major, 8). There was no recanalization of aneurysms with compromised limbs.

Conclusion

Coil embolization of FAs is safe and effective, enabling tailored procedures that accommodate aberrant angioanatomic configurations. Compromise of a single limb during coiling also appears safe, conferring long-term protection from recanalization.

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References

  1. Cooke DL, Stout CE, Kim WT, Kansagra AP, Yu JP, Gu A, Jewell NP, Hetts SW, Higashida RT, Dowd CF, Halbach VV. Cerebral arterial fenestrations. Interv Neuroradiol. 2014;20:261–74.

    Article  Google Scholar 

  2. Sanders WP, Sorek PA, Mehta BA. Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. AJNR Am J Neuroradiol. 1993;14:675–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Arráez-Aybar LA, Villar-Martin A, Poyatos-Ruiperez C, Rodriguez-Boto G, Arrazola-Garcia J. Prevalence of fenestrated basilar artery with magnetic resonance angiography: a transversal study. Surg Radiol Anat. 2013;35:487–93.

    Article  CAS  Google Scholar 

  4. Bayrak AH, Senturk S, Akay HO, Ozmen CA, Bukte Y, Nazaroglu H. The frequency of intracranial arterial fenestrations: a study with 64-detector CT-angiography. Eur J Radiol. 2011;77:392–6.

    Article  Google Scholar 

  5. Bharatha A, Aviv RI, White J, Fox AJ, Symons SP. Intracranial arterial fenestrations: frequency on CT angiography and association with other vascular lesions. Surg Radiol Anat. 2008;30:397–401.

    Article  Google Scholar 

  6. de Gast AN, van Rooij WJ, Sluzewski M. Fenestrations of the anterior communicating artery: incidence on 3D angiography and relationship to aneurysms. AJNR Am J Neuroradiol. 2008;29:296–8.

    Article  Google Scholar 

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

    Article  Google Scholar 

  8. van Rooij SB, Bechan RS, Peluso JP, Sluzewski M, van Rooij WJ. Fenestrations of intracranial arteries. AJNR Am J Neuroradiol. 2015;36:1167–70.

    Article  Google Scholar 

  9. van Rooij SB, van Rooij WJ, Sluzewski M, Sprengers ME. Fenestrations of intracranial arteries detected with 3D rotational angiography. AJNR Am J Neuroradiol. 2009;30:1347–50.

    Article  Google Scholar 

  10. Wu X, Chen X, Zhu J, Chen Q, Li Z, Lin A. Imaging detection of cerebral artery fenestrations and their clinical correlation with cerebrovascular diseases. Clin Imaging. 2020;62:57–62.

    Article  Google Scholar 

  11. Yoshida M, Ezura M, Sasaki K, Chonan M, Mino M. Endovascular repair of ruptured aneurysm arising from fenestration of the horizontal segment of the anterior cerebral artery: case report. Neurol Med Chir (Tokyo). 2012;52:924–7.

    Article  Google Scholar 

  12. Zhao HW, Fu J, Lu ZL, Lü HJ. Fenestration of the anterior cerebral artery detected by magnetic resonance angiography. Chin Med J (Engl). 2009;122:1139–42.

    PubMed  Google Scholar 

  13. Hudák I, Lenzsér G, Lunenkova V, Dóczi T. Cerebral arterial fenestrations: a common phenomenon in unexplained subarachnoid haemorrhage. Acta Neurochir (Wien). 2013;155:217–22.

    Article  Google Scholar 

  14. 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;19:394–401.

    Article  Google Scholar 

  15. Uchino A, Saito N, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Inoue K, Nakajima R, Takahashi M. Fenestrations of the intracranial vertebrobasilar system diagnosed by MR angiography. Neuroradiology. 2012;54:445–50.

    Article  Google Scholar 

  16. Dimmick SJ, Faulder KC. Fenestrated anterior cerebral artery with associated arterial anomalies. Case reports and literature review. Interv Neuroradiol. 2008;14:441–5.

    Article  CAS  Google Scholar 

  17. Leyon JJ, Kaliaperumal C, Choudhari KA. Aneurysm at the fenestrated anterior cerebral artery: surgical anatomy and management. Clin Neurol Neurosurg. 2008;110:511–3.

    Article  Google Scholar 

  18. Chen YY, Chang FC, Hu HH, Chao AC. Fenestration of the supraclinoid internal carotid artery associated with aneurysm and ischemic stroke. Surg Neurol. 2007;68 Suppl 1:S60–3; discussion S63.

    Article  Google Scholar 

  19. 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  PubMed Central  Google Scholar 

  20. Mantatzis M, Kizilkilic O, Albayram S, Kocer N, Islak C. Endovascular treatment of aneurysms associated with fenestrated A1 segment of anterior cerebral artery: report of two cases. J Neuroimaging. 2011;21:165–9.

    Article  Google Scholar 

  21. Patel MA, Caplan JM, Yang W, Colby GP, Coon AL, Tamargo RJ, Huang J. Arterial fenestrations and their association with cerebral aneurysms. J Clin Neurosci. 2014;21:2184–8.

    Article  Google Scholar 

  22. Park SH, Lee CY. Supraclinoid internal carotid artery fenestration harboring an unruptured aneurysm and another remote ruptured aneurysm: case report and review of the literature. J Cerebrovasc Endovasc Neurosurg. 2012;14:295–9.

    Article  Google Scholar 

  23. Kachhara R, Nair S, Gupta AK. Fenestration of the proximal anterior cerebral artery (A1) with aneurysm manifesting as subarachnoid hemorrhage--case report. Neurol Med Chir (Tokyo). 1998;38:409–12.

    Article  CAS  Google Scholar 

  24. Koh JS, Kim EJ, Lee SH, Bang JS. Ruptured aneurysm arising from the distal end of a proximal a(1) fenestration : case report and review of the literature. J Korean Neurosurg Soc. 2009;45:43–5.

    Article  Google Scholar 

  25. Alqahtani SA, Felbaum DR, Tai A, Liu AH, Armonda RA. Endovascular Treatment of Large Unruptured Fusiform Fenestrated Vertebrobasilar Junction Aneurysm. Cureus. 2017;9:e1219.

    PubMed  PubMed Central  Google Scholar 

  26. 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  Google Scholar 

  27. Choi HH, Cho YD, Yoo DH, Lee SH, Yeon EK, Kang HS, Cho WS, Kim JE, Han MH. Safety and efficacy of anterior communicating artery compromise during endovascular coil embolization of adjoining aneurysms. J Neurosurg. 2019;132:1068–76.

    Article  CAS  Google Scholar 

  28. Aktüre E, Arat A, Niemann DB, Salamat MS, Başkaya MK. Bilateral A1 fenestrations: Report of two cases and literature review. Surg Neurol Int. 2012;3:43.

    Article  Google Scholar 

  29. Islak C, Kocer N, Kantarci F, Saatci I, Uzma O, Canbaz B. Endovascular management of basilar artery aneurysms associated with fenestrations. AJNR Am J Neuroradiol. 2002;23:958–64.

    PubMed  PubMed Central  Google Scholar 

  30. Trivelato FP, Abud DG, Nakiri GS, de Castro Afonso LH, Ulhôa AC, Manzato LB, Rezende MT. Basilar Artery Fenestration Aneurysms: Endovascular Treatment Strategies Based on 3D Morphology. Clin Neuroradiol. 2016;26:73–9.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea (Republic of)

    Donghwan Jang

  2. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-Dong, 110-744, Seoul, Korea (Republic of)

    Young Dae Cho, Dong Hyun Yoo & Sung Hyun Kim

  3. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Republic of)

    Won-Sang Cho, Hyun-Seung Kang, Sung Ho Lee & Jeong Eun Kim

  4. Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea (Republic of)

    Heui Seung Lee

  5. Department of Neurosurgery and Radiology, Veterans Health Service Medical Center, Seoul, Korea (Republic of)

    Moon Hee Han

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  1. Donghwan Jang
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Correspondence to Young Dae Cho.

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Conflict of interest

D. Jang, Y.D. Cho, D.H. Yoo, S.H. Kim, W.-S. Cho, H.-S. Kang, S.H. Lee, J.E. Kim, H.S. Lee and M.H. Han declare that they have no competing interests.

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Jang, D., Cho, Y.D., Yoo, D.H. et al. Endovascular Treatment of Fenestration-related Aneurysms. Clin Neuroradiol 32, 99–106 (2022). https://doi.org/10.1007/s00062-021-01043-z

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  • DOI: https://doi.org/10.1007/s00062-021-01043-z

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