Vertebral Artery Fenestration Mimicking Acute Dissection

Bilateral vertebral artery fenestrations in the craniocervical junction region: the clinical role of 3D computed tomography angiography

Fenestration of the vertebral artery (FVA) is a rare occurrence that comprises only 2% of fenestrations formed in the intracranial arteries. Herein, we report a unique case of bilateral FVA in the craniocervical junction (CCJ) region using conventional magnetic resonance angiography (MRA) and three-dimensional computed tomography angiography (3D-CTA). Compared to MRA, 3D-CTA was more sensitive in delineating the FVAs located in the region. Furthermore, it effectively depicted the relationships between the VAs and surrounding bony structures. The clinical implications of FVAs can be better understood in relation to the surrounding bony structures. 3D-CTA is mandatory when performing endovascular and open surgical interventions in and around the VA segments in the CCJ region.

Cerebral arterial fenestration associated with stroke and other cerebrovascular diseases

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.