London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 391 205 Vascular imaging Comparative Ultrastructural and Stereological Analyses of Unruptured and Ruptured Saccu-lar Intracranial Aneurysms E. Korkmaz1, B.H. Verweij2, R. Kleinloog3, I.E. Allijn4, L.H.P. Hekking5, Y.M. Ruigrok6, L. Reg-li7, G.J.E. Rinkel8, J.A. Post9 Utrecht University, Utrecht, THE NETHERLANDS1, University Medical Centre Utrecht (UMCU), Utrecht, THE NETHERLANDS2, University Medical Centre Utrecht (UMCU), Utrecht, THE NETHERLANDS3, Utrecht University, Utrecht, THE NETHERLANDS4, Utrecht Universi-ty, Utrecht, THE NETHERLANDS5, University Medical Centre Utrecht (UMCU), Utrecht, THE NETHERLANDS6, University Medical Centre Utrecht (UMCU), Utrecht, THE NETHERLANDS7, University Medical Centre Utrecht (UMCU), Utrecht, THE NETHERLANDS8, Utrecht University, Utrecht, THE NETHERLANDS9 Background - Patients with intracranial aneurysms (IA) who have a high risk of rupture benefit from preventive treatment, but the ability to identify high risk IA is poor, with size being the main deter-minant. We characterized and quantified (ultra)structural differences between unruptured and rup-tured aneurysm walls, to identify potential determinants of IA rupture. Methods- Six unruptured and six ruptured IA fundi were resected after microsurgical clipping and analyzed by correlative light microscopy (LM) and transmission electron microscopy (TEM). Quan-titative analysis expressed as proportion of the vessel wall area was performed on LM samples and qualitative ultrastructural analysis on TEM samples. Results- Quantitative analysis revealed extensive internal elastic lamina (IEL) thickening in rup-tured aneurysms (36.3% ±15), while thin and fragmented IEL is a common feature in unruptured IA (5.6%±7.1). The analysis also indicated extensive inflammation: Macrophages were more often found in ruptured IA (28.3% ±24) than in unruptured IA (2.7% ±5.5), as were leukocytes (12.85% ±10 in ruptured IA and 0% in unruptured IA). Vasa vasorum in ruptured IA contained vast numbers of inflammatory cells and extravasation of these cells into the vessel wall was observed, both in con-trast to unruptured IA. Conclusions- Compared to unruptured IA, ruptured IA have significantly thicker IEL, and heavy inflammation throughout the vessel wall. Vasa vasorum might be a pathway by which inflammatory cells enter the vessel wall. Differences identified may be helpful in developing tools to identify rup-ture prone IA and thereby tailor treatment of patients with unruptured IA in the future. Figure 2. LM and TEM images of a ruptured aneurysm. (A) Thickened IEL infiltrated with inflammatory cells. Several large vasa vasora present throughout the vessel wall (asterisks). Scale bar= 40 μm (B) TEM image of ruptured IA luminal layer. Scale bar= 5 μm (C) Two large vasa vasara with inflammatory cells within and neighboring regions in the abluminal layer. Scale bar= 5 μm (D) Higher magnification of the ‘leaky’ VV shown in figure 2C. Scale bar= 2 μm
Karger_ESC London_2013
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