Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea (Republic of).
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-Dong, 110-744, Seoul, Korea (Republic of).
Clin Neuroradiol. 2022 Mar;32(1):99-106. doi: 10.1007/s00062-021-01043-z. Epub 2021 Jun 16.
Endovascular treatment of fenestration-related aneurysms (FAs) is prone to technical challenges, given the inherent complexities. Herein, we have analyzed FAs in terms of angioarchitectural characteristics and outcomes achieved through endovascular intervention.
Data accrued prospectively between January 2002 and July 2020 were productive of 105 FAs in 103 patients, each classifiable by the nature of incorporated vasculature as proximal portion, fenestrated limb, or distal end. Our investigation focused on clinical and morphological outcomes, with emphasis on technical aspects of treatment.
The FAs selected for study originated primarily in anterior communicating artery (AcomA: 88/105, 83.8%), followed by basilar (7/105, 6.7%), anterior cerebral (4/105, 3.8%), and internal carotid (3/105, 2.8%) arteries. In nearly all locations, proximally situated aneurysms (43/105, 41%) were more frequent than aneurysms arising at distal ends (3/105, 2.8%), but the majority of AcomA lesions involved fenestrated segments (58/88, 65.9%); and most fenestrated channels (90/105, 85.7%) were asymmetric in size. Orifices of smaller fenestrated limbs were intentionally compromised during coil embolization in 23 aneurysms (21.9%), achieving complete (n = 19) or incomplete (n = 4) compromise, without resultant symptomatic ischemia. Saccular occlusion proved satisfactory in 77 lesions (73.3%). In follow-up monitoring of 100 patients for a mean period of 35.3 ± 26.5 months, 17 instances of recanalization (17.0%) occurred (minor, 9; major, 8). There was no recanalization of aneurysms with compromised limbs.
Coil embolization of FAs is safe and effective, enabling tailored procedures that accommodate aberrant angioanatomic configurations. Compromise of a single limb during coiling also appears safe, conferring long-term protection from recanalization.
血管内治疗吻合相关动脉瘤（FA）容易受到技术挑战，因为存在固有复杂性。在此，我们根据血管解剖结构特征以及血管内干预的结果对 FA 进行了分析。
前瞻性收集 2002 年 1 月至 2020 年 7 月的数据，共纳入 103 例患者的 105 个 FA，每个 FA 均可根据合并血管的性质分为近端部分、吻合肢或远端。我们的研究重点是临床和形态学结果，并强调治疗的技术方面。
选择进行研究的 FA 主要起源于前交通动脉（AcomA：88/105，83.8%），其次是基底动脉（7/105，6.7%）、大脑前动脉（4/105，3.8%）和颈内动脉（3/105，2.8%）。几乎所有部位，近端动脉瘤（43/105，41%）比远端动脉瘤（3/105，2.8%）更常见，但 AcomA 病变大多涉及吻合段（58/88，65.9%）；并且大多数吻合通道（90/105，85.7%）大小不对称。在 23 个动脉瘤中，有 23 个动脉瘤的较小吻合支（21.9%）故意进行了线圈栓塞，达到完全（n=19）或不完全（n=4）栓塞，没有导致症状性缺血。77 个病变（73.3%）的囊状闭塞效果满意。在 100 例患者的平均 35.3±26.5 个月的随访中，有 17 例（17.0%）出现再通（轻微 9 例，严重 8 例）。未再通有吻合支受累的动脉瘤。
FA 的线圈栓塞是安全有效的，可实现针对异常血管解剖结构的定制手术。线圈栓塞时单个吻合支的闭塞也似乎是安全的，可长期防止再通。
