Dual Approach for Basilar Artery Fenestration Aneurysm With Insights From Computational Fluid Dynamics

Area of Science:

• Neuroendovascular surgery
• Cerebrovascular diseases
• Medical imaging analysis

Background:

• Basilar artery fenestration aneurysms (BAFAs) pose significant clinical challenges due to high rupture risk and complex anatomy.
• Effective management requires comprehensive vascular assessment, post-treatment surveillance, and advanced imaging techniques.
• Computational fluid dynamics (CFD) offers promise for preoperative planning in complex cerebrovascular lesions.

Observation:

• A 60-year-old female presented with headaches and a diagnosed BAFA.
• Initial treatment with a pipeline embolization device resulted in a patent aneurysm.
• A secondary stent-assisted coil embolization achieved complete aneurysm occlusion.

Findings:

• Pretreatment CFD analysis of the BAFA revealed significant areas of both low (38.89%) and high (11.5%) wall shear stress (WSS), indicating a high rupture risk.
• Low WSS was observed in daughter sac regions, further suggesting increased rupture potential.
• Streamline analysis identified increased inflow via the right vertebral artery and fenestration limb, informing therapeutic strategy.

Implications:

• This study is the first to integrate CFD for analyzing BAFA morphology and hemodynamics.
• CFD provides critical insights into aneurysm rupture risk and guides treatment selection.
• CFD holds potential for developing individualized, precision-based therapeutic approaches for complex aneurysms.