Basilar artery fenestration associated with aneurysms treated by endovascular approach

Introduction: Arterial fenestrations are associated with saccular aneurysms that are often difficult to treat with open surgical techniques. Basilar artery fenestration reported in the literature is highly variable depending on the technique used. Typically fenestration occurs at the lower end of the basilar artery just at the vertebral arteries join. For basilar artery fenestrations associated with aneurysms endovascular embolization could be the first treatment choice. Methods: This study presented three cases of patients having basilar artery fenestration associated with aneurysm that were treated endovascularly. All patients underwent endovascular embolization by femoral approach, under general anesthesia. Results: In all three cases, no new neurological deficits were reported. Balloon remodeling technique was necessary in one patient that presented kissing aneurysms. The length of the follow-up was 3 years for 2 patients, and 1 year for one patient. All the aneurysms, except one, presented a small recanalization at four vessels digital subtraction angiography (DSA) control, but it remained stable even at the three years control. Conclusions: Endovascular treatment of basilar artery aneurysms associated with fenestrations is a safe and durable option. No second embolization procedure was necessary in our cases. No limb of the fenestration was necessary to be sacrificed. Larger series of patients treated with this method are needed to support our evidence.