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Folia Neuropathologica
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4/2022
vol. 60
 
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abstract:
Original paper

Impact of inflammation-related degenerative changes on the wall strength of unruptured intracranial aneurysms: a pilot study

Leszek Lombarski
1
,
Przemysław Kunert
1
,
Sylwia Tarka
2
,
Tomasz Stępień
3
,
Dominik Chutorański
3
,
Sławomir Kujawski
4
,
Andrzej Marchel
1

  1. Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
  2. Department of Forensic Medicine, Medical University of Warsaw, Warsaw, Poland
  3. Department of Neuropathology, Institute of Psychiatry and Neurology, Warsaw, Poland
  4. Department of Exercise Physiology and Functional Anatomy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
Folia Neuropathol 2022; 60 (4): 403-413
DOI: https://doi.org/10.5114/fn.2022.122342
Online publish date: 2022/12/30
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Introduction
Saccular intracranial aneurysm (sIA) rupture is a serious cerebrovascular event associated with inflammatory destructive processes leading to gradual weakening of the sIA wall. The aim of the present study was to identify the morphological and histological determinants for low wall strength in unruptured sIAs harvested from autopsy subjects.

Material and methods
A total of eight single unruptured sIAs were identified and excised with adjacent cerebral arteries during 8 of 184 postmortem examinations. The dome morphology was assessed for each sIA at a constant pressure of 100 mmHg. Then, after 5 preconditioning cycles which assured muscle fibre relaxation, sIA specimens were subjected to gradually increasing intraluminal pressure at a rate of 20 mmHg/s until rupture of the sIA or cerebral artery was achieved. Micro-structural degenerative changes and inflammatory cell infiltration within the sIA wall were quantitatively analysed after pressurization of the sIA specimens. The microscopic analysis of the slides stained with histological methods (HE, Mallory trichrome, Masson trichrome, orcein) and immunohistochemical methods (LCA, CD3, CD68) was performed.

Results
The wall of the sIA ruptured in three specimens, while in the other cases, rupture occurred at the arterial wall. The mean maximal dome size was significantly larger in sIAs with low wall strength, that is, in sIAs that ruptured during pressurization, than in sIAs with high wall strength (6.46 mm vs. 2.43 mm, p = 0.034). Moreover, a significantly higher average percentage of wall hyalinization in sIAs that ruptured than in sIAs that did not rupture was observed (30% vs. 0%, p = 0.006). In contrast, the degree of inflammatory cell infiltration did not differ between the wall strength categories.

Conclusions
Our results support the observations that larger sIAs may be at a higher risk of rupture. Histological analysis revealed that hyalinization corresponds to the weakened regions of the wall of unruptured sIAs.

keywords:

inflammation, rupture risk, saccular intracranial aneurysm, aneurysm morphology, rupture pressure, hyalinization
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