Endovascular Treatment of Large Unruptured Fusiform Fenestrated Vertebrobasilar Junction Aneurysm

Alqahtani, Saeed A; Felbaum, Daniel R.; Tai, Alex; Liu, Ai‐Hsi; Armonda, Rocco A.

doi:10.7759/cureus.1219

Cited by 6 publications

(10 citation statements)

References 8 publications

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“…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 [4][5][6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%.…”

Section: Discussionmentioning

confidence: 99%

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

Korkmaz¹,

Çınar²,

Nas³

et al. 2021

Turk J Med Sci

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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...

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Section: Discussionmentioning

confidence: 99%

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

Korkmaz¹,

Çınar²,

Nas³

et al. 2021

Turk J Med Sci

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“…8,9 This combination of structural vessel wall abnormality and altered hemodynamics predisposes aneurysm development at the fenestrated vertebrobasilar junction. 2,4,6,10 The reported incidence of vertebrobasilar junction aneurysms is rare at approximately 0.33% of all intracranial aneurysms. 6 In the presence of a vertebrobasilar junction aneurysm, a high index of suspicion must be maintained due to the association with abnormal fenestration in up to 70% of cases, which can alter the treatment approach.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular intervention is preferred for these aneurysms. 3,4 We report 2 cases of fenestrated vertebrobasilar junction aneurysms successfully treated with different endovascular coiling techniques.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Coiling of Fenestrated Vertebrobasilar Cerebral Aneurysms

Liao

Huynh²,

Cicilioni

et al. 2022

Neurointervention

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Fenestrated vertebrobasilar junction aneurysms are uncommon vascular lesions. Surgical intervention remains extremely challenging due to the deep location and complex anatomy with adjacent cranial nerves and perforator vessels. Endovascular approach is safer and generally accepted as the primary treatment method. Optimal angiographic projections with three-dimensional reconstructions to guide microcatheter selection remain vital to successfully treating aneurysms with challenging fenestration anatomy. This report details the endovascular methods in two cases of fenestrated vertebrobasilar junction aneurysms with different coiling techniques.

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“…[4][5][6][7] The location of these aneurysms is proximal to the brainstem, and the wide varieties of the fenestrations complex and the presence of perforator vessels make the microsurgical approach extremely dificcult. 1,2,[8][9][10] An endovascular-based approach is becoming the first-line treatment, and meticulous preprocedural planning is extremely important to study the exact anatomy of the aneurysm-fenestration complex to determine the most appropriate endovascular therapeutic technique, Therefore, the three-dimensional rotational angiography (3DRA) is an extremely helpful tool to plan the endovascular treatment. 11 Kai et al proposed two types of classification.…”

Section: Palavras-chavementioning

confidence: 99%

Aneurysm of the Fenestrated Basilar Artery: Case Report and Literature Review

et al. 2017

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Introduction Aneurysms of the vertebrobasilar junction are rare, but when present, they are often associated with fenestration of the basilar artery. Frequently, the endovascular treatment is the first choice due to the complex anatomy of the posterior fossa, which represents a challenge for the open surgical treatment alternative. Case Report A 47-year-old man was admitted to the emergency unit with headache, diplopia, neck pain and mental confusion. The neurological exam showed: score of 15 in the Glasgow coma scale (GCS), no motor or sensitivity deficit, palsy of the left sixth cranial nerve and Hunt-Hess grade III. The computed tomography (CT) scan showed subarachnoid hemorrhage (Fisher III) and hydrocephalus. The patient was submitted to ventricular-peritoneal shunt. A diagnostic angiography was performed with 3D reconstruction, which showed evidence of fenestration of the basilar artery associated with aneurysm in the right vertebrobasilar portion. An aneurysm coil embolization was performed without complications. The patient was discharged 19 days later maintaining diplopia, with paralysis of the left sixth cranial nerve, but without any other complaints or neurological symptoms. Discussion Fenestration of the basilar artery occurs due to failure of fusion of the longitudinal neural arteries in the embryonic period, and it is associated with the formation of aneurysms. The endovascular treatment is the first choice and several techniques are described, including simple coiling, balloon remodeling, stent-assisted coiling, liquid embolic agents and flow diversion devices. The three-dimensional rotational angiography (3DRA) is an extremely helpful tool when planning the best treatment course. Conclusion Fenestrated basilar artery aneurysms are rare and complex vascular diseases and their treatment improved with the advent of the 3D angiography and the development of the endovascular techniques.

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Endovascular Treatment of Large Unruptured Fusiform Fenestrated Vertebrobasilar Junction Aneurysm

Cited by 6 publications

References 8 publications

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

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

Endovascular Coiling of Fenestrated Vertebrobasilar Cerebral Aneurysms

Aneurysm of the Fenestrated Basilar Artery: Case Report and Literature Review

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