Saccular intracranial aneurysm: pathology and mechanisms

被引:377
作者
Frosen, Juhana [1 ,2 ]
Tulamo, Riikka [2 ]
Paetau, Anders [3 ]
Laaksamo, Elisa [2 ]
Korja, Miikka [1 ,2 ]
Laakso, Aki [1 ,2 ]
Niemela, Mika [1 ,2 ]
Hernesniemi, Juha [1 ,2 ]
机构
[1] Univ Helsinki, Cent Hosp, Dept Neurosurg, SF-00260 Helsinki, Finland
[2] Biomedicum, Neurosurg Res Grp, Helsinki, Finland
[3] Univ Helsinki, Cent Hosp, Dept Pathol, SF-00260 Helsinki, Finland
关键词
Aneurysm; Intracranial; Histopathology; Pathophysiology; Inflammation; GENE-EXPRESSION PROFILES; NECROSIS-FACTOR-ALPHA; SMOOTH-MUSCLE-CELLS; TERM-FOLLOW-UP; SUBARACHNOID HEMORRHAGE; CEREBRAL ANEURYSMS; EXPERIMENTAL INDUCTION; INFLAMMATORY RESPONSE; ARTERIAL ANEURYSMS; SCAVENGER RECEPTOR;
D O I
10.1007/s00401-011-0939-3
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Saccular intracranial aneurysms (sIA) are pouch-like pathological dilatations of intracranial arteries that develop when the cerebral artery wall becomes too weak to resist hemodynamic pressure and distends. Some sIAs remain stable over time, but in others mural cells die, the matrix degenerates, and eventually the wall ruptures, causing life-threatening hemorrhage. The wall of unruptured sIAs is characterized by myointimal hyperplasia and organizing thrombus, whereas that of ruptured sIAs is characterized by a decellularized, degenerated matrix and a poorly organized luminal thrombus. Cell-mediated and humoral inflammatory reaction is seen in both, but inflammation is clearly associated with degenerated and ruptured walls. Inflammation, however, seems to be a reaction to the ongoing degenerative processes, rather than the cause. Current data suggest that the loss of mural cells and wall degeneration are related to impaired endothelial function and high oxidative stress, caused in part by luminal thrombosis. The aberrant flow conditions caused by sIA geometry are the likely cause of the endothelial dysfunction, which results in accumulation of cytotoxic and pro-inflammatory substances into the sIA wall, as well as thrombus formation. This may start the processes that eventually can lead to the decellularized and degenerated sIA wall that is prone to rupture.
引用
收藏
页码:773 / 786
页数:14
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