Fenestration deformity of the basilar artery trunk with an aneurysm

Abstract

Rationale: Fenestration of the basilar artery is most common in the proximal portion near the vertebrobasilar artery junction. Conversely, fenestration of the middle and distal portions of the basilar artery is not common, and fenestration of the basilar artery with an aneurysm is even less common. Patient concerns: This study reports the case of a 37-year-old woman with basilar artery fenestration malformation and an aneurysm at the mid-distal junction; her symptoms included sudden headaches with nausea and vomiting. Diagnoses: Head digital subtraction angiography showed fenestration at the junction of the middle and upper portions of the basilar artery associated with an aneurysm, and spontaneous pseudoaneurysm formation could not be excluded. Interventions: The patient underwent stent-assisted fenestration and channel occlusion. Outcomes: Five months later, no abnormalities were found by head magnetic resonance imaging. The stents were well positioned, and no occluded branches or aneurysms were present. Lessons: For mid-distal basilar artery fenestration malformation with an aneurysm, occlusion of the lesion channel is relatively safe when there are no perforating vessels in the fenestration channel and the lesion channel is a nondominant channel. Overall, more attention should be paid to the possibility of pseudoaneurysm formation in the diagnosis and treatment of this type of aneurysm.

Multiple Ruptured Aneurysms Over Basilar Artery Fenestration: Endovascular Management

“…The histopathological findings in fenestrations are imperfect medial membrane at both edges of the fenestration, elastin defect, and thinning of the subendothelial layer at the proximal end, resulting in a weakened vessel wall. These intrinsic defects coupled with altered hemodynamics (high shear stress and high-speed turbulence) contribute to aneurysm formation and rupture [ 5 ].…”

“…Fenestration of the middle and distal segments is a rare occurrence. Currently, the literature regarding BAF is sparse and is confined mainly to case reports and series [ 5 ].…”

Endovascular treatment of an aneurysm arising from the minor limb of an upper basilar artery fenestration: illustrative case

“…In cases involving a vascular structure such as that in the present case, the herein-described technique may be considered an option for treatment. Zhang et al 17 reported that occlusion of the minor limb is relatively safe when no perforating arteries are present. However, Im et al 6 reported a case of small perforators originating from both the major and minor limbs of an upper BA fenestration.…”

“…[1][2][3]7,8 An aneurysm arising from an upper BA fenestration is extremely rare. We identified only 15 cases in the literature, 3,9-16 including 1 case in the middle-upper part 17 and our case (Table 1). Very few unruptured aneurysms have been reported, and ours is the fifth such case.…”

Acute cerebral infarction of posterior circulation in a patient with vertebral artery fenestration deformity: A case report

“…The shape of cerebrovascular fenestration malformations can be divided into silk-like shape, convex-lens-like shape, duplication shape and irregular shape [ 2 ]. Studies have reported that cerebrovascular fenestration deformity may be related to aneurysms, moyamoya disease, transient ischemic attack, cerebral infarction and other diseases [ 3 , 4 , 5 ]. For young patients with acute cerebral infarction, we must do a good job in differential diagnosis with other etiologies.…”