Anterior communicating artery complex fenestration combined with tandem aneurysm: a case report and literature review

Introduction: Clinically, anterior communicating artery complex fenestration combined with fenestration-related aneurysms is rare, and combination of this condition with tandem aneurysms is even rarer. Patient concerns: A case of a 43-year-old man with spontaneous subarachnoid hemorrhage. Diagnosis: A computed tomography angiography examination revealed a fenestrated anterior communicating artery complex combined with 2 aneurysms. Then, a digital subtraction angiography examination was performed to further determine the diagnosis, which showed a complex anatomical structure of the local tissue. After the aneurysms ruptured, they were partially wrapped by a hematoma and compressed, which increased the difficulty of surgery. Interventions: An endovascular interventional therapy method was chosen, and a simple coil was successfully inserted through the blood vessel into the tandem aneurysms to maintain the integrity of the anatomical structure. Outcomes: The patient recovered well postoperatively. An imaging review after the operation did not show the aneurysms, and the upper and lower branches were patent. Conclusion: Therefore, endovascular treatment is an appropriate choice for arterial fenestration combined with tandem aneurysms, once the aneurysms have ruptured.