Article Figures & Data
Figures
- Fig 1.
Untreated ruptured giant aneurysm. Angiography (A), sagittal sections (B), and microscopic sections (C and D) of a control giant aneurysm 7 days after construction and rupture. Note the thrombosed caudal third (T), the flowing cephalad third (P), and the partially thrombosed middle third of the fundus. While there is neointimal hypertrophy of the wall of the cephalad third (C), there is thrombosis with recanalization of the caudal section and hemorrhagic transformation of the wall (asterisk, B and D). To demonstrate patency of the aneurysm, one must catheterize the aneurysm and inject contrast directly into its lumen. Note recanalization between the clot and wall (arrows in A and D). Movat pentachrome, original magnification ×20. N indicates aneurysm neck.
- Fig 2.
Ruptured and unruptured group 3 aneurysms. Angiography (A and D), sagittal section (B and E), and microscopic sections (C and F) 7 days after surgery. The arrows in A and B show the rupture site in a control partially thrombosed aneurysm (N indicates aneurysm neck). The asterisks in D and E show the recurrent aneurysm in a thrombosed lesion lacking an endothelial lining. Note recanalization between the clot and the wall of the control aneurysm, absent in the aneurysm lacking an endothelial lining, and the presence of blood on both sides of the attenuated aneurysm wall media in both cases (asterisks, C and F). C and F, Movat pentachrome, original magnification ×20.
- Fig 3.
Aneurysm wall. Microscopic section of the wall of the aneurysms, 4 (A and D) and 7 (B and C) days after surgery. Note normal wall (A), thickened, attenuated wall in a thrombosed aneurysm with hemorrhagic infiltration of the adventitia (B and C), with (C) or without (B) recanalization. Note extrusion of endoaneurysmal clot (C) through complete rupture of the wall (arrow, D). HPS (A and D) and Movat pentachrome (B and C), original magnification ×20 (A and D), ×50 (B and C).
- Fig 4.
Recanalization and rupture. Recanalized endothelialized crescents can be found in thrombosed aneurysms as early as 4 days after aneurysm construction and rupture. A, W indicates venous wall; R, recanalization. HPS, original magnification ×50 (A). Original magnification ×100 (B).
- Fig 5.
Bleeding despite clipping. Angiography (A), sagittal section (B), and microscopic pathology (C and D) of giant aneurysms constructed and clipped 7 days before. Note severe displacement of the right carotid artery by hematoma (A), but the aneurysm is completely clipped. Recanalization between the clot and the aneurysm wall can be seen (B and C). The attenuated wall (W) with intraluminal thrombosis (T) and perianeurysmal blood (B) is shown (C). D, Microscopic sections immune-stained with α-actin show infiltration of the clot with myofibroblasts and the formation of endothelialized vascular spaces (asterisk) between the clot and the wall (W).
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