Purpose

Endovascular treatment of fenestration-related aneurysms (FAs) is prone to technical challenges, given the inherent complexities. Herein, we have analyzed FAs in terms of angioarchitectural characteristics and outcomes achieved through endovascular intervention.

Methods

Data accrued prospectively between January 2002 and July 2020 were productive of 105 FAs in 103 patients, each classifiable by the nature of incorporated vasculature as proximal portion, fenestrated limb, or distal end. Our investigation focused on clinical and morphological outcomes, with emphasis on technical aspects of treatment.

Results

The FAs selected for study originated primarily in anterior communicating artery (AcomA: 88/105, 83.8%), followed by basilar (7/105, 6.7%), anterior cerebral (4/105, 3.8%), and internal carotid (3/105, 2.8%) arteries. In nearly all locations, proximally situated aneurysms (43/105, 41%) were more frequent than aneurysms arising at distal ends (3/105, 2.8%), but the majority of AcomA lesions involved fenestrated segments (58/88, 65.9%); and most fenestrated channels (90/105, 85.7%) were asymmetric in size. Orifices of smaller fenestrated limbs were intentionally compromised during coil embolization in 23 aneurysms (21.9%), achieving complete (n = 19) or incomplete (n = 4) compromise, without resultant symptomatic ischemia. Saccular occlusion proved satisfactory in 77 lesions (73.3%). In follow-up monitoring of 100 patients for a mean period of 35.3 ± 26.5 months, 17 instances of recanalization (17.0%) occurred (minor, 9; major, 8). There was no recanalization of aneurysms with compromised limbs.

Conclusion

Coil embolization of FAs is safe and effective, enabling tailored procedures that accommodate aberrant angioanatomic configurations. Compromise of a single limb during coiling also appears safe, conferring long-term protection from recanalization.

中文翻译：

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开窗相关动脉瘤的血管内治疗

目的

考虑到固有的复杂性，开窗相关动脉瘤 (FAs) 的血管内治疗容易面临技术挑战。在此，我们根据血管结构特征和通过血管内介入实现的结果分析了 FA。

方法

2002 年 1 月至 2020 年 7 月期间前瞻性收集的数据在 103 名患者中产生了 105 个 FA，每个患者都可根据合并血管系统的性质分类为近端部分、有孔肢体或远端。我们的调查侧重于临床和形态学结果，重点是治疗的技术方面。

结果

选择用于研究的 FA 主要起源于前交通动脉 (AcomA: 88/105, 83.8%)，其次是基底动脉 (7/105, 6.7%)、大脑前动脉 (4/105, 3.8%) 和颈内动脉 (3 /105, 2.8%) 动脉。在几乎所有位置，近端动脉瘤 (43/105, 41%) 比远端动脉瘤 (3/105, 2.8%) 更常见，但大多数 AcomA 病变涉及开窗节段 (58/88, 65.9%) ); 大多数有孔通道 (90/105, 85.7%) 大小不对称。23 个动脉瘤 (21.9%) 在弹簧圈栓塞期间有意破坏较小的有孔肢体的孔口，达到完全 ( n  = 19) 或不完全 ( n = 4) 妥协，没有导致症状性缺血。77 个病灶（73.3%）的囊状闭塞被证明是令人满意的。在对 100 名患者的平均 35.3 ± 26.5 个月的随访监测中，发生了 17 例（17.0%）再通（轻微，9 例；严重，8 例）。肢体受损的动脉瘤没有再通。

结论

FAs 的线圈栓塞是安全有效的，可实现适应异常血管解剖结构的定制程序。在盘绕过程中折断单肢似乎也是安全的，可提供长期保护以防止再通。