Concurrent basilar artery double fenestration with aneurysm and vertebral artery dissection: case report and literature review of rare cerebrovascular abnormalities.

Abstract

Many disorders can cause aneurysm and/or dissection of the cerebral arteries, including fibromuscular dysplasia (FMD), connective tissue disorders, cerebral vasculitis, infection, and vascular malformations. Arterial fenestration is a rare congenital finding that can also cause aneurysms, and can rarely dissect and bleed. Treatment of aneurysm and dissection with subarachnoid hemorrhage can be very complicated, and requires case-by-case analysis of the risks and benefits of antithrombotic therapy. To the authors' knowledge, no case of double fenestration of the basilar artery has been reported. This report presents a case of concurring vertebral artery dissection and double fenestration of the basilar artery with aneurysm. The fenestration and FMD are considered possible main contributing causes of this presentation. A literature review of cerebrovascular fenestration and FMD is provided and the relationship between the 2 is considered. Lastly, the use of antithrombotic therapy in the setting of subarachnoid hemorrhage, dissection, and stent placement is discussed.

• Authors: Madeline M Stark, Nedaa Skeik, Josser E Delgado Almandoz, Benjamin M Crandall, David E Tubman
• Journal: Annals of vascular surgery (Ann Vasc Surg) Vol. 27 Issue 4 Pg. 497.e15-21 (May 2013) ISSN: 1615-5947 [Electronic] Netherlands
• PMID: 23548267 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Adult
• Basilar Artery (abnormalities, diagnostic imaging, surgery)
• Cerebral Angiography
• Diagnosis, Differential
• Female
• Humans
• Intracranial Aneurysm (congenital, diagnostic imaging, surgery)
• Magnetic Resonance Angiography
• Tomography, X-Ray Computed
• Vascular Malformations (surgery, therapy)
• Vascular Surgical Procedures (methods)
• Vertebral Artery (abnormalities, diagnostic imaging, surgery)
• Vertebral Artery Dissection (congenital, diagnostic imaging, surgery)