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Cerebral arterial fenestrations: a common phenomenon in unexplained subarachnoid haemorrhage

  • Clinical Article - Vascular
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Abstract

Background

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).

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

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Conflicts of interest

The authors do not have any personal or institutional financial interest in the drugs, materials, or devices described in this submission.

Funding

The Hungarian National Research Council supported this study with grant TAMOP 4.2.2.A-11.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Pécs, 2 Ret str, 7623, Pécs, Hungary

    Istvan Hudák, Gabor Lenzsér & Tamás Dóczi

  2. Department of Radiology, University of Pécs, Pécs, Hungary

    Veronika Lunenkova

  3. MTA-PTE Clinical Neuroscience MR Research Group, University of Pécs, Pécs, Hungary

    Tamás Dóczi

Authors
  1. Istvan Hudák
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  2. Gabor Lenzsér
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  3. Veronika Lunenkova
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  4. Tamás Dóczi
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Correspondence to Tamás Dóczi.

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Hudák, I., Lenzsér, G., Lunenkova, V. et al. Cerebral arterial fenestrations: a common phenomenon in unexplained subarachnoid haemorrhage. Acta Neurochir 155, 217–222 (2013). https://doi.org/10.1007/s00701-012-1587-7

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  • DOI: https://doi.org/10.1007/s00701-012-1587-7

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