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Review ArticleReview Articles
Open Access

Mechanisms of Healing in Coiled Intracranial Aneurysms: A Review of the Literature

W. Brinjikji, D.F. Kallmes and R. Kadirvel
American Journal of Neuroradiology July 2015, 36 (7) 1216-1222; DOI: https://doi.org/10.3174/ajnr.A4175
W. Brinjikji
aFrom the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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D.F. Kallmes
aFrom the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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R. Kadirvel
aFrom the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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  • Fig 1.
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    Fig 1.

    A, Zero-to-7 days: thin fibrin layer covers the coils (tan). Macrophage invasion is seen in the coil periphery (purple). Unorganized thrombus surrounds the coils (red). A thin-but-incomplete fibrin layer is seen at the aneurysm neck. B, One-to-2 weeks: increased fibrin coating of the coils (tan). Macrophages in the coil periphery (purple) and myofibroblast invasion (green) are seen. Note the thin fibrin layer at aneurysm neck. Endothelialization at the neck periphery and along the coil is seen. C, Two weeks to 1 month: increased myofibroblast invasion (green). Thrombus is more organized (red), and macrophages in the aneurysm periphery (purple) are seen. Note increased endothelialization of the aneurysm neck. D, One-to-3 months: decreased cellularity occurs within the aneurysm. Myofibroblasts (dark green) and macrophages (dark purple) die through apoptosis. Note increased endothelialization of the aneurysm neck. E, Three months plus: the aneurysm dome is acellular. Vascularized connective tissue is seen in the aneurysm dome (red fibers). Note increased fibrin coverage of coils (tan) and endothelialization of the aneurysm neck. There is a progressive increase in the amount of collagen within the aneurysm through 3 months.

  • Fig 2.
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    Fig 2.

    A and B, Histopathologic hematoxylin-eosin stains (original magnification ×15 and ×60, respectively) of a rabbit aneurysm dome 1 week postcoiling demonstrate unorganized thrombus filling the aneurysm dome around the coil loops. No endothelialization has occurred at the aneurysm neck. Histopathologic hematoxylin-eosin stains (original magnification ×10 and ×150, respectively) for a rabbit aneurysm dome 6 weeks postcoiling demonstrate loose connective tissue in the aneurysm dome surrounding the coil loops (C) and an incomplete layer of endothelium-lined neointima over the aneurysm neck (D). The neointima and endothelial cells at the neck interface are both continuous with that of the parent artery. E and F, Histopathologic hematoxylin-eosin stains (original magnification ×10 and ×15, respectively) 12 months postcoiling demonstrate loose connective tissue in the aneurysm dome surrounding coil loops (E) and a layer of neointima of variable thickness covering the aneurysm neck (F). The neointima and endothelial cells at the neck interface are both continuous with those of the parent artery. G and H, Histopathologic hematoxylin-eosin stains (original magnification, ×20 and ×125, respectively) of the aneurysm dome 12 months postcoiling demonstrate loose connective tissue in the aneurysm dome.

Tables

  • Figures
  • Characteristics of well-healed aneurysms

    Characteristics
    Anatomic/angiographic
        Increased packing attenuation
        Smaller aneurysm volume
        High aspect ratio
    Histologic
        Complete thrombus formation
        Myofibroblast infiltration
        Collagen deposition in aneurysm dome
        Complete endothelialized neointimal layer
    Molecular
        Osteopontin expression
        Cell-signaling and cell-adhesion molecule expression
        C-reactive protein
        Fibronectin expression
        Expression of inhibitors of apoptosis
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American Journal of Neuroradiology: 36 (7)
American Journal of Neuroradiology
Vol. 36, Issue 7
1 Jul 2015
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Mechanisms of Healing in Coiled Intracranial Aneurysms: A Review of the Literature
W. Brinjikji, D.F. Kallmes, R. Kadirvel
American Journal of Neuroradiology Jul 2015, 36 (7) 1216-1222; DOI: 10.3174/ajnr.A4175

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Mechanisms of Healing in Coiled Intracranial Aneurysms: A Review of the Literature
W. Brinjikji, D.F. Kallmes, R. Kadirvel
American Journal of Neuroradiology Jul 2015, 36 (7) 1216-1222; DOI: 10.3174/ajnr.A4175
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