2017 年 11 巻 6 号 p. 309-314
Objective: Arterial fenestration is an unusual anatomic variation and is often associated with aneurysms. Aneurysm arising from the fenestration of the horizontal segment of the anterior cerebral artery (A1) is considered to be rare.
Case Presentation: We report a case of a 61-year-old man who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm of fenestrated A1 segment of the anterior cerebral artery. Cerebral angiogram revealed an aneurysm at right A1 fenestration. The aneurysm was embolized by coils, leading to complete occlusion, while preserving both channels of the fenestration. On the 11th postoperative day, the patient suffered cerebral embolic stroke due to paroxysmal atrial fibrillation and his left proximal middle cerebral artery was occluded. He is doing rehabilitation for right hemiparesis and aphasia but remains severely disabled.
Conclusion: Considering that dissection of fenestrated A1 aneurysms is sometimes difficult, and there are several branches from one or both channels of fenestration, endovascular therapy would have some advantages over the neck clipping.
