Oishi Hidenori, Mishima Yumiko, Yatomi Kenji, Teranishi Kosuke, Suzuki Kazumoto, Fujii Takashi
Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
Department of Neuroendovascular Therapy, Juntendo University Faculty of Medicine, Tokyo, Japan.
NMC Case Rep J. 2021 Apr 2;8(1):33-37. doi: 10.2176/nmccrj.cr.2020-0107. eCollection 2021 Apr.
The authors report a rare autopsy case. A 59-year-old woman underwent flow diverter (FD) therapy using a pipeline embolization device (PED) for a large paraclinoid internal carotid artery aneurysm. Follow-up magnetic resonance (MR) examinations were performed 6 months after the treatment. Although the T2-weighted images showed progressive thrombosis of the aneurysm, the silent MR angiography (MRA) clearly showed the residual blood flow within the aneurysm. The patient committed suicide 2 months after the follow-up MR examinations. An autopsy specimen showed a small section of the defective membranes with the PED that matched the entry point of residual blood flow seen clearly in the silent MRA. Macroscopic photograph and hematoxylin and eosin stained sections showed defective endothelialization. In contrast, complete endothelialization was observed in membranes covering the PED. The autopsy findings after FD therapy showed defective endothelialization that perfectly matched and corroborated the silent MRA findings.
作者报告了一例罕见的尸检病例。一名59岁女性因大型床突旁颈内动脉瘤接受了使用管道栓塞装置（PED）的血流导向（FD）治疗。治疗后6个月进行了随访磁共振（MR）检查。尽管T2加权图像显示动脉瘤内血栓形成进展，但无创磁共振血管造影（MRA）清楚地显示动脉瘤内仍有残余血流。患者在随访MR检查后2个月自杀。尸检标本显示PED周围一小段有缺陷的膜，与无创MRA中清晰可见的残余血流入口点相匹配。大体照片和苏木精-伊红染色切片显示内皮化缺陷。相比之下，覆盖PED的膜观察到完全内皮化。FD治疗后的尸检结果显示内皮化缺陷，与无创MRA结果完全匹配且相互印证。
