Pathomorphological Examination of Patients with the Simultaneous Rupture of Dissecting Intracranial Vertebral and Intraperitoneal Arteries: Involvement of Segmental Arterial Mediolysis in Intracranial Artery Dissection

Abstract

Objective: To examine the involvement of segmental arterial mediolysis (SAM) in intracranial artery dissection. Methods:In four autopsy cases of subarachnoid hemorrhage related to the rupture of the intracranial vertebral artery (IVA) with intraperitoneal hemorrhage, we calculated the extent of arterial dissection using elastica van Gieson staining from the tissue sections of the left/right IVAs and intraperitoneal arteries (IPAs), and examined the properties of the vascular smooth muscle and responses of mesenchymal cells using immunostaining with anti-α smooth muscle antibody (SMA) and anti-S100A4 antibodies. Results:The length of the adventitia at the site of IVA rupture was ≤2.4 mm, and that of disruptions of the internal elastic lamina was 5.4-11 mm. The IVA/IPA rupture sites showed acute arterial dissection. In the blood vessels at the sites of dissection, defect/necrosis of the vascular smooth muscle, which are characteristic of SAM, were noted. In three cases, the topical infiltration of mesenchymal cells was observed in the adventitia at the dissected site of the ruptured IVA. In all cases, dissection of unruptured intracranial or -peritoneal arteries was also present. Its pathological properties vary from acute to old dissection. Conclusion:Autopsy revealed SAM-related systemic multiple arterial dissection in all cases, suggesting the involvement of SAM in the development of intracranial artery dissection.

A Case of Segmental Arterial Mediolysis: Hemoperitoneum with Hemorrhagic Shock due to Rupture of a Visceral Artery Aneurysm Following Subarachnoid Hemorrhage

“…These may have been a cause of visceral artery aneurysm rupture or promoted hemoperitoneum. Many SAM cases in which hemoperitoneum developed in the acute phase of SAH were reported from Japan, 3,4,[6][7][8][9][10]12) suggesting a racial difference concerning onset. However, are the internal carotid artery and vertebral artery.…”

“…Several SAM cases with hemoperitoneum that developed in the acute phase of SAH from intracranial aneurysm rupture were recently reported. [3][4][5][6][7][8][9][10][11][12] Case reports of SAM with hemoperitoneum that developed in the acute phase of SAH are presented in Table 1. Based on analysis of the present case and previously reported cases, hemoperitoneum the accumulation and investigation of patients are necessary.…”

“…Moreover, induction of subarachnoid and hemoperitoneum by the rupture of SAM-induced intracranial and visceral artery aneurysms within a short time has been reported, although it is rare. [2][3][4][5][6][7][8][9][10][11][12] We report a patient in whom an aneurysm ruptured in a visceral artery 6 days after the onset of SAH induced by rupture of an anterior communicating artery aneurysm, causing hemorrhagic shock.…”

Low-profile visible intraluminal support stent-assisted embolization therapy for intracranial dissecting aneurysms: A retrospective analysis of six cases

“… 7 When the intima and media are involved, the vascular lumen may be narrowed or even occluded. 7 , 8 Blood infiltration into the adventitia often results in bulging of the wall leading to the formation of a sandwich aneurysm. 7 Furthermore, the outer layer of the bulging arterial wall is often weak with no tissue support around it making it prone to dissection.…”

“… 7 Furthermore, the outer layer of the bulging arterial wall is often weak with no tissue support around it making it prone to dissection. 7 , 8 IDAs are special types of dissection aneurysms that often results in SAH with arterial vasospasms as well as ischemic stroke. 9 , 10 Our study revealed that, the occurrence of DAs is very rare since we identified only six case within 3-years period at our institution.…”