Mizukami M, Kin H, Araki G, Mihara H, Yoshida Y
Acta Neurochir (Wien). 1976;34(1-4):247-59. doi: 10.1007/BF01405880.
Systematic morphological study of the cerebral arteries was made in six autopsy cases of ruptured aneurysms. The time course of the arterial luminal narrowing was observed by repeated angiograms, and segments of the narrowed arteries were studied histologically. Various histological changes were found consistent with the angiographic findings. We have devided these into three stages according to the duration of the disease. In the acute stage (less than one day) the contraction of the medial smooth muscle cells may be the main cause of the luminal narrowing. In the subacute stage, arteries showed a reduction in lumen size with medial thickening, marked corrugation of the internal elastic lamina, and thrombus formation attached to the endothelial surface. If vasoconstriction remained localized to the same segment for several days, the intimal or medial thickening and thrombus might produce the luminal narrowing consistent with the angiographic narrowing. In the chronic stage (more than two weeks), most cases showed dilatation of the arterial lumen on angiography. These arteries showed frank necrosis of the smooth muscle cells histologically. In a case which demonstrated progressive luminal narrowing on angiograms over 2 weeks, the arterial wall showed luminal narrowing with cellulofibrous thickening of the intima and organization of the thrombus. The presence of these structural changes in the narrowed arteries seen at angiography seems to be very important for proper understanding and treatment of vasospasm.
对6例动脉瘤破裂尸检病例的脑动脉进行了系统的形态学研究。通过重复血管造影观察动脉管腔狭窄的时间进程，并对狭窄动脉段进行组织学研究。发现了各种与血管造影结果一致的组织学变化。根据病程，我们将这些变化分为三个阶段。在急性期（小于1天），血管平滑肌细胞的收缩可能是管腔狭窄的主要原因。在亚急性期，动脉显示管腔大小减小，伴有中层增厚、内弹性膜明显皱襞以及附着在内皮表面的血栓形成。如果血管收缩在同一节段持续数天，内膜或中层增厚以及血栓可能导致与血管造影狭窄一致的管腔狭窄。在慢性期（超过两周），大多数病例在血管造影时显示动脉管腔扩张。这些动脉在组织学上显示平滑肌细胞明显坏死。在一例血管造影显示2周以上管腔进行性狭窄的病例中，动脉壁显示管腔狭窄，内膜有纤维性增厚以及血栓机化。血管造影所见狭窄动脉中的这些结构变化对于正确理解和治疗血管痉挛似乎非常重要。
