Stiver S I, Porter P J, Willinsky R A, Wallace M C
Department of Surgery, The Toronto Hospital, Ontario, Canada.
Neurosurgery. 1998 Nov;43(5):1203-8. doi: 10.1097/00006123-199811000-00106.
This case study provided us with the opportunity to explore the histopathological effects of Guglielmi detachable coil (GDC) therapy on the aneurysm orifice and parent vessel-aneurysm neck interface. This type of study is important to the understanding of the mechanisms of obliteration of aneurysms by GDCs.
The patient presented with a Hunt and Hess Grade III subarachnoid hemorrhage that occurred secondary to the rupture of a small anterior communicating artery aneurysm.
The aneurysm was successfully coiled without complication, but the patient died 36 hours later. We examined the gross and microscopic pathological findings of this GDC-treated anterior communicating artery aneurysm 36 hours after coiling. A discrete membrane composed of fibrin had formed completely across the aneurysm orifice, excluding the aneurysm sac from the circulation. This membrane was contiguous with the parent vessel.
This case represents one of the first examples in humans of the formation of a membrane over the aneurysm orifice after GDC therapy. The formation of this membrane, shown to be composed of fibrin, was found at 36 hours after coiling, which is the earliest time frame at which membrane formation has been noted in either humans or animal models. This fibrin membrane may function both as a scaffold for subsequent endothelialization across the aneurysm neck as well as to isolate the aneurysm from the parent circulation, permitting thrombus within the aneurysm sac to mature to an endovascular scar. The factors contributing to the formation of this membrane and its clinical implications are discussed.
本病例研究为我们提供了一个机会，来探究 Guglielmi 可脱卸弹簧圈（GDC）治疗对动脉瘤开口及载瘤血管 - 动脉瘤颈部界面的组织病理学影响。这类研究对于理解 GDC 闭塞动脉瘤的机制很重要。
患者因小型前交通动脉瘤破裂继发 Hunt 和 Hess 分级为 III 级的蛛网膜下腔出血。
动脉瘤成功进行了弹簧圈栓塞，无并发症发生，但患者在 36 小时后死亡。我们在弹簧圈栓塞 36 小时后检查了该接受 GDC 治疗的前交通动脉瘤的大体和显微镜下病理结果。一层由纤维蛋白构成的离散膜完全横跨动脉瘤开口形成，使动脉瘤囊与循环隔绝。该膜与载瘤血管相连。
本病例是人类中 GDC 治疗后动脉瘤开口处形成膜的首批实例之一。该膜的形成在弹簧圈栓塞 36 小时时被发现，其由纤维蛋白构成，这是在人类或动物模型中最早记录到膜形成的时间框架。这种纤维蛋白膜可能既作为后续横跨动脉瘤颈部内皮化的支架，又将动脉瘤与载瘤循环隔离开，使动脉瘤囊内的血栓成熟为血管内瘢痕。文中讨论了促成该膜形成的因素及其临床意义。
