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AJNR - American Journal of Neuroradiology

Published ahead of print on January 17, 2008
doi: 10.3174/ajnr.A0902

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Mechanisms of Occlusion and Recanalization in Canine Carotid Bifurcation Aneurysms Embolized with Platinum Coils: An Alternative Concept

J. Raymond^a, T. Darsaut^a,b, I. Salazkin^a, G. Gevry^a and F. Bouzeghrane^a

^a Interventional Neuroradiology Laboratory, CHUM Research Centre, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Quebec, Canada
^b Department of Surgery, Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada

View larger version (15K): [in this window] [in a new window]   Fig 1. Schematic illustration of T- and Y-type carotid bifurcation aneurysm models.

View larger version (95K): [in this window] [in a new window]   Fig 2. Angiographic and macroscopic results. Angiography (A, C, E) and macroscopic photographs (B, D, F) of prototypical cases of recurrence at 3 months and poor neointimal closure (A and B), complete occlusions at 3 months with good neointimal closure of the neck (C and D), and angiographic occlusion but with poor neointimal closure of the neck (E and F). Note that the coils have been removed in D.

View larger version (127K): [in this window] [in a new window]   Fig 3. Macroscopic and pathologic findings of aneurysm with complete angiographic occlusion at 3 months after coil embolization. A, Photograph of aneurysmal neck en face. Note complete closure of the neck by a translucent layer of membrane tissue. B, Low-magnification overview of an axial aneurysm section showing a continuous layer of smooth muscle (SM) -actin+ cells completely sealing the neck of the aneurysm. At higher magnification (C and D are magnifications of the inset c,d in B), closed corner (arrows in B and C) shows aligned SM -actin+ cells covered by a single layer of NOS+ endothelial cells. E, The same neointimal layer is continuous, isolating the aneurysm from the circulation. F, SM -actin immunostaining of atrophied aneurysmal wall. Sections are hematoxylin-counterstained (scale bar: 1000 µm for B; 200 µm for C–F; 40 µm for insets in C and D).

View larger version (147K): [in this window] [in a new window]   Fig 4. Macroscopic and pathologic findings of recurring aneurysm 3 months after coil embolization. A, Macroscopic photograph showing incomplete neck closure. B, Low magnification of overview of axial aneurysm section revealing a recurring lesion extending from the corner of the neck to the body of the aneurysm (arrow). These crescentic spaces are lined by smooth muscle (SM) –actin+ cells (C) and covered with NOS+ endothelial cells (D). E, Higher magnification showing the same layer of SM -actin+ cells covered with NOS+ endothelial cells. F, Atrophy of the aneurysmal wall in the occluded zone. G, No atrophy of the aneurysmal wall in the recurring zone. Sections are hematoxylin-counterstained (scale bar: 1000 µm for B; 200 µm for C–G; 40 µm for insets in C and D).

View larger version (116K): [in this window] [in a new window]   Fig 5. Common findings of occluded and recurrent aneurysms. Macroscopic views with coils protruding into the lumen vessel before (A) and after coil retrieval (B). Note that all coils are re-covered with neointima, which consists of smooth muscle (SM) cells (C) embedded in a collagenous matrix surrounded by a unique layer of NOS+ cells (D). Note polypoid filaments (pink arrows in A and E) observed at the neck of aneurysms, with a similar neointima organization (F). Sections are hematoxylin-counterstained (scale bar: 200 µm for C, D, and F; 40 µm for insets in C, D, and F).

View larger version (162K): [in this window] [in a new window]   Fig 6. Vascularized connective tissues are similarly organized in occluded (A and C) and recurrent (B and D) aneurysm with smooth muscle (SM) –actin+ cells, presumably myofibroblast (A and B) and NOS+ cells for neovascularization (C and D) (scale bar: 200 µm).

View larger version (79K): [in this window] [in a new window]   Fig 7. Tissues infiltrating the core of the coils. Immunostaining of smooth muscle (SM) –actin (A), of NOS (B), and Movat pentachrome stain (C) shows the same structure as the vascularized tissue inside the aneurysm (scale bar: 200 µm).

View larger version (32K): [in this window] [in a new window]   Fig 8. Schematic illustration summarizing the differences between occlusion and recanalization.