Ye Dan, Huang Jinzhong, Wang Sulei, Sheng Shiying, Liu Meng
Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou.
Department of Neurology, Nanjing Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, PR China.
Neuroreport. 2021 Nov 2;32(16):1279-1286. doi: 10.1097/WNR.0000000000001720.
Cerebral arterial fenestration is a rare vascular malformation that has not been fully understood. Whether it is related to cerebrovascular diseases remains to be determined. In this study, we aimed to investigate the imaging characteristics of cerebral fenestrations, the clinical characteristics of fenestrations complicated with cerebrovascular diseases, and the correlation between fenestrations and cerebrovascular diseases.
We reviewed the magnetic resonance imaging and computed tomography (CT) imaging findings of patients with cerebrovascular fenestrations in the Third Affiliated Hospital of Soochow University from January 2016 to December 2020, mainly focused on the shape and location of fenestrations. According to the location of fenestrated arteries, patients were divided into the internal carotid arterial system (ICAS) group and the vertebrobasilar arterial system (VAS) group. For patients complicated with cerebrovascular diseases, detailed data about the demographics and clinical characteristics were recorded. Stroke patients with injured lesions located in the territories of fenestrated arteries were further screened out and analyzed. Moreover, the proportions of cerebrovascular diseases including stroke between the ICAS group and the VAS group were compared.
A total of 280 cerebrovascular fenestrations were found in 274 patients (six patients had two fenestrations). The most frequently involved vessels were the anterior cerebral artery (123/280), the basilar artery (76/280) and the vertebral artery (35/280). As to the shape of fenestrations, slit-like fenestrations accounted for 63.2% (177/280), followed by convex-lens-like type 26.1% (73/280) and duplicated type 10.7% (30/280). A total of 70 patients were complicated with cerebrovascular diseases, including ischemic stroke 64.3% (45/70), hemorrhagic stroke 22.9% (16/70), aneurysm 10% (7/70), arteriovenous malformation 1.4% (1/70) and cavernous hemangioma 1.4% (1/70). There were no significant differences between the ICAS group and the VAS group in terms of the demographics and clinical characteristics. Furthermore, among the 61 patients complicated with stroke, 16 patients' stroke lesions were located in the territories of fenestrated arteries, including 12.5% (2/16) in the ICAS and 87.5% (14/16) in the VAS. In addition, compared with the ICAS group, the proportions of cerebrovascular diseases including stroke in patients with fenestrations were higher in the VAS group (P < 0.05).
Cerebral arterial fenestrations are most commonly found in the anterior cerebral artery, the basilar artery and the vertebral artery. Vertebrobasilar fenestrations are more related to cerebrovascular diseases, especially stroke.
大脑动脉窗是一种罕见的血管畸形，目前尚未完全明确。其是否与脑血管疾病相关仍有待确定。在本研究中，我们旨在探讨大脑动脉窗的影像学特征、合并脑血管疾病时的临床特征以及动脉窗与脑血管疾病之间的相关性。
我们回顾了2016年1月至2020年12月苏州大学附属第三医院脑血管动脉窗患者的磁共振成像和计算机断层扫描（CT）成像结果，主要关注动脉窗的形态和位置。根据动脉窗所在动脉的位置，将患者分为颈内动脉系统（ICAS）组和椎基底动脉系统（VAS）组。对于合并脑血管疾病的患者，记录详细的人口统计学和临床特征数据。进一步筛选出病变位于动脉窗供血区域的卒中患者并进行分析。此外，比较ICAS组和VAS组中包括卒中在内的脑血管疾病的比例。
在274例患者中发现了280处脑血管动脉窗（6例患者有两处动脉窗）。最常受累的血管是大脑前动脉（123/280）、基底动脉（76/280）和椎动脉（35/280）。关于动脉窗的形态，裂隙样动脉窗占63.2%（177/280），其次是凸透镜样占26.1%（73/280），重复样占10.7%（30/280）。共有70例患者合并脑血管疾病，包括缺血性卒中64.3%（45/70）、出血性卒中22.9%（16/70）、动脉瘤10%（7/70）、动静脉畸形1.4%（1/70）和海绵状血管瘤1.4%（1/70）。ICAS组和VAS组在人口统计学和临床特征方面无显著差异。此外，在61例合并卒中的患者中，16例患者的卒中病变位于动脉窗供血区域，其中ICAS组占12.5%（2/16），VAS组占87.5%（14/16）。另外，与ICAS组相比，VAS组中合并动脉窗的患者发生包括卒中在内的脑血管疾病的比例更高（P < 0.05）。
大脑动脉窗最常见于大脑前动脉、基底动脉和椎动脉。椎基底动脉窗与脑血管疾病尤其是卒中的关系更为密切。
