M1 fenestration of the middle cerebral artery is rare. We present two patterns of acute thromboembolic conditions in M1 fenestrations treated with mechanical thrombectomy. Case 1 was a male in his 60s presenting with right hemiparesis and aphasia. Angiography showed acute left M1 proximal occlusion; the first direct aspiration revealed two parallel routes, and the second aspiration achieved complete recanalization of the left M1 fenestration. Case 2 was a male in his 70s presenting right hemiparesis and aphasia. Angiography revealed a sudden stair-like narrowing of the left M1 in the intermediate part, and a retrograde blood flow cavity was observed on the upper side of the distal part. Mechanical thrombectomy was performed to diagnose the upper limb occlusion of the left M1 fenestration, and successful recanalization was achieved through direct aspiration. Anatomical variations, such as fenestration, should be considered to reduce complication risks.
Keywords: M1 fenestration; mechanical thrombectomy.
© 2024 The Japan Neurosurgical Society.