Dissecting aneurysm of the intracranial vertebral artery associated with proximal focal degeneration of the elastica. A comparative pathological study of the vertebral artery in patients with and without aneurysms

Masaru Yamada, Yoshio Miyasaka, Saburo Yagishita, Kiyotaka Fujii, Takashi Yoshimoto, H. Hunt Batjer

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: The pathogenesis underlying intracranial dissecting aneurysms remains unclear. We performed a detailed study using vertebral artery specimens obtained at autopsy from patients with and without aneurysms to identify the primary abnormality resulting in weakness of the elastica. We compared our observations with those made in specimens manifesting the normal atherosclerotic process. Methods: Using histologic methods, we examined intracranial vertebral artery specimens from two autopsied aneurysm patients and 13 autopsied control cases to compare the state of atherosclerosis and the weakness of the elastica at this aneurysm predilection site. Results: Case 1: A 54-year-old woman with 2 dissecting aneurysms of the bilateral vertebral arteries (VA) who died from recurrent subarachnoid hemorrhage (SAH). Case 2: A 53-year-old woman who died from SAH. Microscopically, all 3 vertebral aneurysms were typical transmural dissecting aneurysms. They manifested areas of focal, severe degeneration of the elastic lamina and calcification at VA sites proximal to the aneurysms. These lesions could be differentiated from secondary changes attributable to the aneurysms because of their separate location only proximal to the site of aneurysmal rupture. Atherosclerotic changes were minimal in both cases. In the controls, the degenerative state of the elastic lamina of the VA reflected an atherosclerotic process. Conclusions: We postulate that focal degeneration of elastic tissue not involved in the atherosclerotic process was the vasculopathy resulting in aneurysm formation in our SAH cases.

Original languageEnglish (US)
Pages (from-to)431-437
Number of pages7
JournalSurgical neurology
Volume60
Issue number5
DOIs
StatePublished - Nov 2003

Keywords

  • Atherosclerosis
  • Dissecting aneurysm
  • Subarachnoid hemorrhage
  • Vertebral artery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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