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Basilar artery fenestration

Dr Yuranga Weerakkody and Dr Jeremy Jones et al.

A basilar artery fenestration (or simply, basilar fenestration) is the most common intracranial arterial fenestration. It refers to duplication of a portion of the artery. Its reported is highly variable depending on the technique used:

0.3 - 0.6% at angiography (presumably low due to preferential laminar flow in only one lumen at a time)
2% on MRA
up to 5.26% at autopsy

Typically fenestration occurs at at the lower end of the basilar artery just as the vertebral arteries join. However, it can also be seen in the mid-basilar and distal (tip).

There is an increased incidence of basilar aneurysm formation at the site of fenestration, presumably due to abnormal flow dynamics. They are reported in 7% of fenestrations.

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References

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1. Tasker AD, Byrne JV. Basilar artery fenestration in association with aneurysms of the posterior cerebral circulation. Neuroradiology. 1997; 39(3): 185-9. doi:10.1007/s002340050389 [pubmed citation]
2. Bharatha A, Aviv RI, White J, Fox AJ, Symons SP. Intracranial arterial fenestrations: frequency on CT angiography and association with other vascular lesions. Surg Radiol Anat. 2008; 30(5): 397-401. doi:10.1007/s00276-008-0340-7 [pubmed citation]