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Inflammation promotes progression of thrombi in intracranial thrombotic aneurysms

  • Hime Suzuki
  • Takeshi MikamiEmail author
  • Tomoaki Tamada
  • Ryo Ukai
  • Yukinori Akiyama
  • Akinori Yamamura
  • Kiyohiro Houkin
  • Nobuhiro Mikuni
Original Article
  • 10 Downloads

Abstract

Advances in the understanding of the pathogenesis of arteriosclerosis, abdominal aorta aneurysms and dissections, and carotid artery plaques have focused on chronic inflammation. In this study, we report that inflammatory changes of thrombi contribute to the enlargement and growth of giant intracranial thrombotic aneurysms. Surgical and postmortem samples were collected from 12 cases of large or giant intracranial thrombotic aneurysms diagnosed via pathological investigations. Degeneration of the aneurysmal wall and the infiltration of inflammatory cells in the thrombi were assessed. The number of blood cells and immunohistochemical stain-positive cells was enumerated, and the inflammation and neovascularization in the thrombi were assessed. In all cases, the appearance of inflammatory cells (CD68+ cells, CD206+ cells, lymphocytes, and neutrophils) was apparent in the thrombi. The number of CD34+ cells was moderately correlated with the number of CD68+ cells, and CD34+ cells significantly and strongly correlated with the number of CD206+ cells. Based on the number of neutrophils per CD68+ cells, we classified the cases into 2 groups: a macrophage inflammation-dominant group and a neutrophilic inflammation-dominant group. The neutrophilic inflammation-dominant group had significantly more cases with previous treatments and neurological symptoms due to mass effect than the macrophage inflammation-dominant group. Chronic inflammation due to macrophages in thrombi is a fundamental mechanism in the enlargement of an intracranial thrombotic aneurysm, and neutrophilic inflammation can accelerate this process. Microvascularization in thrombi is linked to inflammation and might promote thickening of the intima and repeated intimal microbleeds.

Keywords

Thrombotic aneurysm Inflammation Cerebral aneurysm 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest..

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (The ethics committee of Sapporo Medical University Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Patient consent was obtained with an opt-out policy using a website as this study was a retrospective case series. Therefore, formal consent was not required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgerySapporo Medical UniversitySapporoJapan
  2. 2.Department of Neurosurgery, Graduate School of MedicineHokkaido UniversitySapporoJapan

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