Cerebral arterial fenestrations

A common phenomenon in unexplained subarachnoid haemorrhage

Istvan Hudák, Gabor Lenzsér, Veronika Lunenkova, T. Dóczi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Fenestrations of intracranial arteries are variants resulting from incomplete fusion of vessels during development with unknown clinical significance. They are best visualised with 3D rotational angiography (3DRA). Objective: In a prospective consecutive series of patients with suspected aneurysms, 3DRA was performed to identify not only the potential bleeding source but also to assess the frequency and location of any fenestrations of intracranial arteries. Methods: In 287 consecutive patients with possible intracranial aneurysms (accidental discovery or previous history of SAH), 3DRAs were prospectively performed, and the location of subarachnoid haemorrhage was assessed by CT. Results: Of 174 patients presenting with SAH, 153 had saccular aneurysms, and in 21 cases (12.1 %), no source of bleeding was found. In 20 of these 21 patients with «unexplained SAH» (95.2 %) an arterial fenestration was detected in the neighbourhood of the clot. The incidence of fenestration in the 153 aneurysmal SAH patients was 22.9 %, and it was 23.3 % in 266 patients with intracranial aneurysms (113 accidental and 153 ruptured). Conclusions: Arterial fenestration was detected in 22.9 % of ruptured cerebral aneurysms, in contrast with 95.2 % in patients with unexplained SAH, the difference being statisctically significant (p <0.01). Fenestration is a developmental defect, a structural wall weakness possibly making the vessel prone to rupture. Its incidence of nearly 100 % may suggest a connection with idiopathic SAH. The presented data indicate that arterial fenestrations are generally overlooked, and they can be considered as one of the candidates for the source of idiopathic SAH.

Original languageEnglish
Pages (from-to)217-222
Number of pages6
JournalActa Neurochirurgica
Volume155
Issue number2
DOIs
Publication statusPublished - Feb 2013

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Subarachnoid Hemorrhage
Intracranial Aneurysm
Aneurysm
Angiography
Arteries
Hemorrhage
Ruptured Aneurysm
Incidence
Rupture

Keywords

  • Aneurysm
  • Angiography
  • Arterial fenestration
  • Subarachnoid haemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Cerebral arterial fenestrations : A common phenomenon in unexplained subarachnoid haemorrhage. / Hudák, Istvan; Lenzsér, Gabor; Lunenkova, Veronika; Dóczi, T.

In: Acta Neurochirurgica, Vol. 155, No. 2, 02.2013, p. 217-222.

Research output: Contribution to journalArticle

Hudák, Istvan ; Lenzsér, Gabor ; Lunenkova, Veronika ; Dóczi, T. / Cerebral arterial fenestrations : A common phenomenon in unexplained subarachnoid haemorrhage. In: Acta Neurochirurgica. 2013 ; Vol. 155, No. 2. pp. 217-222.
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abstract = "Background: Fenestrations of intracranial arteries are variants resulting from incomplete fusion of vessels during development with unknown clinical significance. They are best visualised with 3D rotational angiography (3DRA). Objective: In a prospective consecutive series of patients with suspected aneurysms, 3DRA was performed to identify not only the potential bleeding source but also to assess the frequency and location of any fenestrations of intracranial arteries. Methods: In 287 consecutive patients with possible intracranial aneurysms (accidental discovery or previous history of SAH), 3DRAs were prospectively performed, and the location of subarachnoid haemorrhage was assessed by CT. Results: Of 174 patients presenting with SAH, 153 had saccular aneurysms, and in 21 cases (12.1 {\%}), no source of bleeding was found. In 20 of these 21 patients with «unexplained SAH» (95.2 {\%}) an arterial fenestration was detected in the neighbourhood of the clot. The incidence of fenestration in the 153 aneurysmal SAH patients was 22.9 {\%}, and it was 23.3 {\%} in 266 patients with intracranial aneurysms (113 accidental and 153 ruptured). Conclusions: Arterial fenestration was detected in 22.9 {\%} of ruptured cerebral aneurysms, in contrast with 95.2 {\%} in patients with unexplained SAH, the difference being statisctically significant (p <0.01). Fenestration is a developmental defect, a structural wall weakness possibly making the vessel prone to rupture. Its incidence of nearly 100 {\%} may suggest a connection with idiopathic SAH. The presented data indicate that arterial fenestrations are generally overlooked, and they can be considered as one of the candidates for the source of idiopathic SAH.",
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