title: 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.affiliation: Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 620, Minneapolis, MN 55407, USA.
authors.forename: Madeline M
authors.initials: MM
authors.lastname: Stark
authors.forename: Nedaa
authors.initials: N
authors.lastname: Skeik
authors.forename: Josser E
authors.initials: JE
authors.lastname: Delgado Almandoz
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Crandall
authors.forename: David E
authors.initials: DE
authors.lastname: Tubman
mesh_terms: D000328:Adult; D001488:Basilar Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery; D018810:Magnetic Resonance Angiography; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000601:surgery / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D020217:Vertebral Artery Dissection / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery