Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2021 Feb;146:e607-e617. doi: 10.1016/j.wneu.2020.10.131. Epub 2020 Oct 29.
Aneurysms associated with fenestrations of intracranial arteries are exceptionally rare findings. Management strategies for these aneurysms are not well-defined, especially regarding endovascular treatment. We sought to investigate the strategies and feasibility of endovascular treatment approaches for various fenestration-associated intracranial aneurysms.
We performed a retrospective chart review of 2000 aneurysms treated endovascularly, identifying 8 aneurysms located at arterial fenestrations. The technical details and procedural outcomes were reviewed to identify common management approaches, technical nuances, and treatment outcomes.
There were 3 (37.5%) aneurysms associated with fenestrations of the basilar artery or vertebrobasilar junction. All 3 were successfully treated with a previously undescribed coil-assisted flow-diversion technique, resulting in complete obliteration. Three (37.5%) aneurysms were associated with fenestrations of the anterior communicating artery. Of those, 2 were successfully treated with stent-assisted coil embolization and 1 with coil embolization alone. One (12.5%) aneurysm was associated with a fenestration of the paraclinoid internal carotid artery and 1 (12.5%) aneurysm found was at the takeoff of the posterior inferior cerebellar artery at a fenestration of the vertebral artery. Both were successfully treated with coil-assisted flow diversion. There were no permanent procedural complications. Major considerations for endovascular management of these aneurysms were the dominance of fenestration trunks, aneurysms arising from the fenestration apex or a fenestration limb, amenability to flow diversion, and anticipation of vascular remodeling.
Fenestration-associated aneurysms are very rare. We have identified common factors to help guide decision-making for endovascular approaches and demonstrate successful aneurysm treatment using these methods.
颅内动脉吻合处相关的动脉瘤是非常罕见的发现。这些动脉瘤的治疗策略尚未明确，特别是针对血管内治疗。我们旨在探讨各种吻合处相关颅内动脉瘤的血管内治疗方法的策略和可行性。
我们对 2000 例接受血管内治疗的动脉瘤进行了回顾性图表审查，确定了 8 例位于动脉吻合处的动脉瘤。我们回顾了技术细节和程序结果，以确定常见的管理方法、技术细节和治疗结果。
有 3 例（37.5%）动脉瘤与基底动脉或椎基底动脉交界处的吻合处有关。所有 3 例均成功地采用了以前未描述的线圈辅助血流转向技术进行治疗，结果完全闭塞。3 例（37.5%）动脉瘤与前交通动脉吻合处有关。其中，2 例采用支架辅助线圈栓塞治疗，1 例采用单纯线圈栓塞治疗。1 例（12.5%）动脉瘤与颈内动脉床突旁吻合处有关，1 例（12.5%）动脉瘤位于椎动脉吻合处的小脑后下动脉起始处。两者均采用线圈辅助血流转向成功治疗。无永久性程序并发症。这些动脉瘤血管内治疗的主要考虑因素是吻合干的优势、起源于吻合顶点或吻合支的动脉瘤、对血流转向的顺应性以及血管重塑的预期。
吻合处相关的动脉瘤非常罕见。我们已经确定了常见的因素，以帮助指导血管内方法的决策，并展示了使用这些方法成功治疗动脉瘤。
