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Zedde M, Moratti C, Di Cecco G, Valzania F, Pascarella R. Limb Occlusion of P1 Posterior Cerebral Artery Fenestration as a Cause of Stroke. Stroke 2024; 55:e134-e135. [PMID: 38586955 DOI: 10.1161/strokeaha.124.046573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit (M.Z., F.V.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit (C.M., G.D.C., R.P.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanna Di Cecco
- Neuroradiology Unit (C.M., G.D.C., R.P.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit (M.Z., F.V.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit (C.M., G.D.C., R.P.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Xu L, Chen X, Xiang W, Wei H, Liang Z. Retrospective analysis of image characteristics of 76 cases of cerebral vascular fenestrations. Front Neurol 2022; 13:986167. [PMID: 36570449 PMCID: PMC9772005 DOI: 10.3389/fneur.2022.986167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives This study aims to summarize the clinical and imaging features of cerebral vascular fenestration and to explore the association between cerebral vascular fenestration and cerebral infarction and aneurysm. Materials and methods The computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) imaging data of 76 cases of cerebral vascular fenestration from January 2021 and December 2021 in the Yantai Yuhuangding Hospital Affiliated to Qingdao University were analyzed. The general information was described. The location, morphology, and size of cerebral vascular fenestration were described. The association between cerebral vascular fenestration and infarction and aneurysm was analyzed. Results Among 76 patients, a total of 80 fenestrations were detected (two patients had three fenestrations), and basilar artery fenestration was the most common (28/80). The fenestration <5 mm was 43/80, 5-10 mm was 12/80, and ≥10 mm was 25/80. Moreover, 19 patients had other vascular diseases: 10 with aneurysms, 5 with moyamoya diseases, and 4 with cerebral artery dissections. Except for one aneurysm at the site of the fenestration, other aneurysms were separate from the fenestrations. In addition, 37 patients had cerebral infarctions, of which 16 had cerebral infarctions in the blood supply area of the arterial fenestration. Among these 16 patients, there was more cerebral infarction in posterior circulation than in anterior circulation. However, no statistically significant differences were detected in the risk factors between the fenestration-relevant cerebral infarctions group and the non-fenestration-relevant cerebral infarctions group. Conclusion In our study, cerebral vascular fenestration occurred most frequently in the basilar artery and may be combined with other vascular diseases. Fenestration in posterior circulation may be related to cerebrovascular diseases. Nonetheless, no clear clinical relevance was observed between fenestration and cerebral infarction. Also, we did not find a definite association between fenestration and aneurysm. For fenestration patients with cerebral infarctions, long-term antiplatelet and statin therapy may be safe and effective.
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Liao M, Huynh K, Cicilioni K, Kumar RPP. Endovascular Coiling of Fenestrated Vertebrobasilar Cerebral Aneurysms. Neurointervention 2022; 17:195-199. [PMID: 36281539 PMCID: PMC9626606 DOI: 10.5469/neuroint.2022.00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
Fenestrated vertebrobasilar junction aneurysms are uncommon vascular lesions. Surgical intervention remains extremely challenging due to the deep location and complex anatomy with adjacent cranial nerves and perforator vessels. Endovascular approach is safer and generally accepted as the primary treatment method. Optimal angiographic projections with three-dimensional reconstructions to guide microcatheter selection remain vital to successfully treating aneurysms with challenging fenestration anatomy. This report details the endovascular methods in two cases of fenestrated vertebrobasilar junction aneurysms with different coiling techniques.
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Affiliation(s)
- Millie Liao
- Department of Vascular & Interventional Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
- Correspondence to: Millie Liao, DO, MS Department of Vascular & Interventional Radiology, Loma Linda University Medical Center, 11234 Anderson St., Loma Linda, CA 92354, USA Tel: +1-909-558-4000 Fax: +1-909-558-0202 E-mail:
| | - Kenneth Huynh
- Department of Vascular & Interventional Radiology, University of California–Irvine, Orange, CA, USA
| | - Kurt Cicilioni
- Department of Vascular & Interventional Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Ramachandran Pillai Promod Kumar
- Department of Vascular & Interventional Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Zhang W, Xing W, Zhong G, He J. Acute cerebral infarction of posterior circulation in a patient with vertebral artery fenestration deformity: A case report. Heliyon 2022; 8:e11210. [PMID: 36325143 PMCID: PMC9618973 DOI: 10.1016/j.heliyon.2022.e11210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 09/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Cerebrovascular fenestration malformation is a rare congenital vascular variation. Cerebrovascular fenestration malformation rarely directly leads to cerebral infarction, and the mechanism of cerebral infarction is not clear. Cases of young patients with vertebral artery fenestration malformation who suffered from acute cerebral infarction of posterior circulation are rare and have not been reported widely. Patient concerns A 36-year-old male patient, who had been in good health and without a family history of stroke, was admitted to our hospital with a 6-h history of dizziness and unstable walking. Diagnosis Brain MR examination showed multiple irregular high signal lesions in the left thalamus, left occipital lobe and left cerebellum. Brain MR enhancement examination confirmed multiple cerebral infarction in left thalamus, left occipital lobe and left cerebellum. CT angiography of head and neck showed fenestration deformity of V2–V3 segment of left vertebral artery. Interventions Considering that the patient was suffering from acute cerebral infarction of posterior circulation, he was treated with antiplatelet, lipid-lowering and plaque stabilization, etc. Outcomes After receiving our treatment, the patient's symptoms were relieved. At 3 and 6 months after discharge, there was no dizziness, unstable walking, no acute cerebral infarction, which meant that the patient recovered well. Conclusion In the absence of traditional risk factors and other evidence of cryptogenic stroke, the cerebral infarction in the blood supply area of fenestration malformation should be considered to be related to fenestration malformation, but its pathogenesis is not clear. Antiplatelet therapy, lipid-lowering and plaque stabilization, etc. are effective in prevention of new infarction for such patients.
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The Incidence, Localization and Clinical Relevance of Arterial Fenestrations and Their Association to Brain Aneurysms: A Case-Control Study Based on the STROBE Guidelines. Brain Sci 2022; 12:brainsci12101310. [PMID: 36291244 PMCID: PMC9599761 DOI: 10.3390/brainsci12101310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Fenestrations are rare, but well-known, vascular variations of the cerebral arteries. They are mostly incidental, asymptomatic angiographic findings and might precipitate vascular lesions such as AVM, aneurysmal dilatation, or even ischemic symptoms. However, association between arterial fenestration and brain aneurysms has not been clearly established. Objective: To evaluate whether incidence of arterial fenestrations are associated with brain aneurysm development and investigate the prevalence and most-common localizations of arterial fenestrations of the human brain. Design: Case−control study. Setting: All patients examined by CT angiography in University Hospital No. 4 in Lublin from 2009 to 2019. Patients: Each patient showing at least one cerebral aneurysm was included in the case group and each patient without cerebral aneurysm on CT angiography was included in the control group. Measurements: CT angiography examinations were conducted using the standard protocol used in the 1st Department of Radiology, Medical University of Lublin, Poland. The database and statistical research were conducted by use of the Statistica software (ver. 13.3, Tibco Software Inc., Palo Alto, CA, USA). Results: A total of 6545 CTA examinations were included in the study. Most of the aneurysms were located on the MCA: 629 (38.59%), ICA: 466 (28.59%) and AComA: 192 (11.78%). Cerebral arterial fenestration showed a non-statistically significant elevated risk for brain aneurysms in the entire study population (OR: 1.157; 95% CI: 0.826−1.621; p = 0.39). Among 6545 cranial CTA examinations, cerebral vessel fenestration was found in 49 of them, which constituted 0.75%. The most common vascular fenestrations were those located in the ACA (30.61%), BA (30.61%) and AComA (22.45%), while other fenestrations occurred infrequently. There were no significant differences in the age of patients in the individuals with vascular fenestration (p > 0.05). VA fenestration was slightly more common in men (16.67%) than in women (5.41%). However, these differences were not statistically significant (p = 0.216). Limitations: Our study has several limitations, including selection bias regarding examined population. Second, we assume that the total number of fenestrations detected in our study was underestimated due to the limitations of the CT method in comparison to other radiologic modalities. Conclusions: Cerebral arterial fenestrations are rare vascular malformations. The ACA is the most common localization of fenestrations, followed by BA and AComA. Fenestrations of cerebral arteries insignificantly increase the risk of cerebral aneurysm formation. Further prospective studies are necessary to make this association more precise.
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Mei Y, Guan D, Tong X, Liu Q, Hu M, Chen G, Li C. Association of cerebral infarction with vertebral arterial fenestration using non-Newtonian hemodynamic evaluation. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:7076-7090. [PMID: 35730297 DOI: 10.3934/mbe.2022334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Cerebral artery fenestration is a rare vascular anomaly, but its existence has been increasingly documented. The association of cerebral infarction and fenestration is of great clinical interest, and the exact underlying mechanism remains unclear. This study aims to identify risk factors contributing to cerebral infarction by computational hemodynamics analysis. METHODS Eight patients with image findings of fenestration structure were recruited in this research, in which four suffered fenestration-related cerebral infarction (A series) while the other four (B series) were set as control matched by the fenestration size. Three-dimensional models were reconstructed from the MRA images and computational simulations with non-Newtonian flow model were performed to get interested hemodynamic characteristics. RESULTS The blood flow pattern was relatively separated along two channels of fenestration in series A compared with series B cases in Group 1-2, however, no significant difference was shown in Group 3-4. Quantitatively, planes were cut in the middle of fenestrations and the ratio of mass flow rate and area was calculated at systolic peak. Results showed that the side of the dominant blood supply was opposite between A and B series, and the dominant side was also opposite between small and large fenestrations. In infarction cases, the basilar top was distributed with larger areas of detrimental hemodynamic indicators and a larger concentrated high viscosity region. CONCLUSION The flow division condition throughout the fenestration structure has a key impact on further flow redistribution and flow pattern. The blood viscosity has the potential to be a useful tool in identifying the risk factors for cerebral infarction and more emphasis should be placed on the hemodynamic environment at superior cerebellar arteries.
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Affiliation(s)
- Yuqian Mei
- School of Medical Imaging, North Sichuan Medical College, Nanchong, China
- College of Life Science, Mudanjiang Medical University, Mudanjiang, China
| | - Debao Guan
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Xinyu Tong
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Qian Liu
- College of Life Science, Mudanjiang Medical University, Mudanjiang, China
| | - Mingcheng Hu
- Department of Radiology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Guangxin Chen
- Medical Image College, Mudanjiang Medical University, Mudanjiang, China
| | - Caijuan Li
- Department of Ultrasound, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
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Sousa JA, Cruz LR, Almendra L, Sargento-Freitas J. Recanalisation of an occluded fenestrated branch of a basilar artery. BMJ Case Rep 2022; 15:e249086. [PMID: 35379685 PMCID: PMC8981357 DOI: 10.1136/bcr-2022-249086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- João André Sousa
- Neurology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Luis Rito Cruz
- Serviço de Imagem Médica, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Luciano Almendra
- Neurology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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Dong J, Mei Y, Bai X, Tong X, Dmytriw AA, Yang B, Wang T, Patel AB, Yang X, Li M, Yang R, Chen D, Jiao L. Hemodynamic Differences Between Basilar Artery Fenestration and Normal Vertebrobasilar Artery: A Pilot Study. Front Neurol 2022; 12:766174. [PMID: 35095723 PMCID: PMC8792536 DOI: 10.3389/fneur.2021.766174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Basilar artery fenestration has been proposed as a contributor to ischemic stroke, as unique flow patterns induced by fenestration may be related to thrombus formation or insufficiency. This study aimed to evaluate the hemodynamics of basilar artery fenestration (BAF) using computational fluid dynamics (CFD). Methods: Patients with BAF and normal vertebrobasilar system were recruited and separately evaluated using CFD. Specific geometric vascular models were reconstructed based on 3D-rotational angiography (3D-RA). Patients were divided into the BAF group and control group (i.e., patients with the normal vertebrobasilar system). Hemodynamic and geometric variables were calculated and compared between groups using Student's t-test or Wilcoxon rank-sum test. Results: Overall, 24 patients were included, with 12 patients each in the BAF group and the control group. The BAF group had a significantly smaller basilar artery diameter than the control group (3.1 ± 0.51 vs. 3.76 ± 0.4, p = 0.002). Compared to the control group, the BAF group had higher values of maxOSI (median, 0.3 vs. 0.09, p = 0.028), TAWSSG (median, 983.42 vs. 565.39, p = 0.038) in the flow confluence, higher SAR-TAWSSG in bifurcation (median, 70.22 vs. 27.65, p = 0.002) and higher SAR-TAWSSG in basilar artery (median, 48.75 vs. 16.17, p < 0.001) of the vertebrobasilar artery. Conclusions: This pilot study suggested that hemodynamic differences between BAF and normal vertebrobasilar artery across multiple shear flow parameters. The disturbed flow in the BAF may increase the risk of thrombus formation, plaque instability, and subsequent ischemic cerebrovascular events. These should be confirmed by future studies.
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Affiliation(s)
- Jia Dong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Interventional Neuroradiology Diagnosis and Treatment Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuqian Mei
- School of Life Science, Beijing Institute of Technology, Beijing, China.,School of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Xinyu Tong
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Adam A Dmytriw
- Interventional Neuroradiology Diagnosis and Treatment Center, Xuanwu Hospital, Capital Medical University, Beijing, China.,Neuroendovascular Program, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Aman B Patel
- Neuroendovascular Program, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Xiaoyan Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mengyue Li
- Interventional Neuroradiology Diagnosis and Treatment Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Interventional Neuroradiology Diagnosis and Treatment Center, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
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Ye D, Huang J, Wang S, Sheng S, Liu M. Cerebral arterial fenestration associated with stroke and other cerebrovascular diseases. Neuroreport 2021; 32:1279-1286. [PMID: 34554937 DOI: 10.1097/wnr.0000000000001720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Dan Ye
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou
| | - Jinzhong Huang
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou
| | - Sulei Wang
- Department of Neurology, Nanjing Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, PR China
| | - Shiying Sheng
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou
| | - Meng Liu
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou
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