Imaging features of vertebral artery fenestration

Area of Science:

• Vascular imaging
• Congenital anomalies
• Neuroradiology

Background:

• Vertebral artery fenestration (VAF) is a rare congenital vascular anomaly.
• VAF shares imaging similarities with vertebral artery dissection (VAD), potentially complicating diagnosis.
• VAF is associated with intracranial aneurysms.

Purpose of the Study:

• To determine the prevalence of VAF.
• To evaluate the association of VAF with other vascular anomalies.
• To identify imaging features that differentiate VAF from VAD.

Main Methods:

• Retrospective review of CTA and MRA head and neck imaging reports from 2010-2017.
• Identification and analysis of VAF and VAD cases.
• Comparison of imaging features and clinical presentations between VAF and VAD groups using statistical analysis.

Main Results:

• VAF prevalence was 0.1% (67/64,888), similar to VAD (0.1%, 54/64,888).
• VAFs were shorter, wider, more often in the V4 segment, and more likely to have two lumens compared to VADs.
• Intracranial aneurysms were present in 9% of VAF patients; VAFs were less likely to be post-traumatic than VADs.

Conclusions:

• VAF is distinguishable from VAD on angiographic imaging.
• The diagnosis of VAF necessitates evaluation for intracranial aneurysms.