Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review

Abstract

IntroductionBasilar artery fenestration (BAF) is a rare vascular variation and its incidence is reported as 0.6-2.33% depending on the diagnostic modality chosen [1][2][3]. Fenestrations on this region increase tendency to aneurysm generation [2]. Complex geometric structure of the fenestration, proximity to lower cranial nerves, presence of sort of vital arterial structures, and deep and challenging nature of this region for surgery increase mortality and morbidity of surgical treatment in these aneurysms [4]. Endovascular treatment is becoming the first choice at the present time [5]. However, experiences on endovascular treatment are limited in the literature because of the rarity of these aneurysms.Our aim in this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methodsA total of 26 BAF aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography (CTA), and digital subtraction angiography (DSA) before the procedure. Ruptured and nonruptured aneurysms were included in the study. Patients with aneurysms unrelated to BAF were excluded. Aneurysms were divided into two groups: narrow-necked (neck diameter lower than 4 mm or dome/neck ratio higher than 2) and wide-necked (neck diameter higher than 4 mm or dome/neck ratio lower than 2) [6].All patients were treated with endovascular method under general anesthesia after hospitalization. Systemic heparinization was performed in all patients ensuring an activated clotting time (ACT) of 250-300 s. After femoral artery puncture, angiograms of both carotid and vertebral arteries were obtained selectively. Endovascular Background/aim: The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methods:A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure.Results: Aneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%, while these rates are 100%, 92%, and 7.6% in our study, respectively. Conclusion:Although the number of cases is low in our study, to our knowledge, it is the widest series in the li...

Reconstructive endovascular treatment of basilar artery fenestration aneurysms: A multi-centre experience and literature review

“…7 No specific angiographic FU and AOR were available. 4,5,8 The immediate AOR in our study is comparable to those described in the literature with complete and successful AOR of 69% (v. 66–91%) and 83% (v. 75–100%), respectively. 4–8 However, a comparison between the studies is difficult as treatment strategies have changed over time and new equipment for endovascular therapy of intracranial aneurysms has come to the market including different types of microcatheters, stents and flow diverting devices.…”

“…flow diverters were used. 8 In the present study, aneurysms also were treated with intra-saccular flow disruption (WEB), which was recently described as feasible treatment option for this type of lesion. 11…”

“…Another reasonable treatment option for wide-necked BAFAs is SAC, 5,7,8 but use in ruptured cases might carry risk of haemorrhagic complications due to intraoperative application of antiplatelet medication. 15 In our cohort, four out of seven aneurysms initially treated with SAC suffered from baseline SAH, but due to the complex morphology of aneurysm and neck coiling (alone or in combination with balloon remodelling), was not sufficient.…”

Multiple Ruptured Aneurysms Over Basilar Artery Fenestration: Endovascular Management

“…Aneurysms are classified based on their size as small (diameter less than 11 mm), large (diameter of 11-25 mm), or giant (diameter greater than 25 mm) [ 7 ]. The treatment options for aneurysms include standard coiling, balloon-assisted therapies, stent-assisted therapies, and flow-diverter systems [ 8 ]. Vajpeyee et al in 2013 used a novel double microcatheter-assisted technique for coiling a BAF aneurysm [ 9 ].…”

“…One patient had a permanent neurological deficit, and another patient died following surgical treatment [ 12 ]. In 2021, a comprehensive review of literature by Korkmaz et al reaffirmed the notion that ET is superior to a microsurgical approach in terms of higher clinical success rate and lower complication rate [ 8 ].…”