Endovascular treatment of unruptured intracranial aneurysms and circulating endothelial cells

Objectives: To evaluate the potential implication of circulating endothelial cells (CECs) in complications following endovascular treatment (EVT) of unruptured intracranial aneurysms. CECs characterized as CD146(+)/CD105(+)/CD45(-)/DAPI(+) were considered to originate from an altered endothelial cell layer of the vessel wall. Study design: In 15 patients, CECs were characterized and enumerated by the CellTracks(R) System in blood samples from: (1) femoral artery (FA), (2) internal carotid artery (ICA) before (ICA1) and after procedure (ICA2), and (3) a peripheral vein before (PV1) and after EVT (PV2). Ischemic brain events were assessed using diffusion weighted imaging (DWI-MRI) before and 24 h after EVT. Results: In ICA1, the median number of single CECs and clusters of 2-5 CECs were higher than in FA, ICA2, PV1 and PV2 samples (P < 0.001). Clusters >5 cells, sometimes >50 mu m, were mainly observed in ICA1 and never in PV1, PV2 or PV samples from ten healthy subjects. This distribution of CECs suggested femoral and ICA injury by the devices used, leading to endothelium shearing and desquamation of CECs. All patients discharged on day two (NIHSS score = 0), however silent ischemic brain lesions were observed in 9/15 (60%). Conclusions: EVT detaches single and clusters of CECs from wall arteries that may be implicated in silent ischemic brain lesions genesis. Enumeration of CECs associated with DWI-MRI might represent an interesting strategy for monitoring and optimizing endovascular devices, and further limit EVT-related complications. (C) 2012 Elsevier Ireland Ltd. All rights reserved.