Comparative ultrastructural and stereological analyses of unruptured and ruptured saccular intracranial aneurysms

Emine Korkmaz, Rachel Kleinloog, Bon H. Verweij, Iris E. Allijn, Liesbeth H.P. Hekking, Luca Regli, Gabriel J.E. Rinkel, Ynte M. Ruigrok*, Jan Andries Post

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)


Insight into processes leading to rupture of intracranial aneurysms (IAs) may identify biomarkers for rupture or lead to management strategies reducing the risk of rupture. We characterized and quantified (ultra)structural differences between unruptured and ruptured aneurysmal walls. Six unruptured and 6 ruptured IA fundi were resected after microsurgical clipping and analyzed by correlative light microscopy for quantitative analysis (proportion of the vessel wall area) and transmission electron microscopy for qualitative ultrastructural analysis. Quantitative analysis revealed extensive internal elastic lamina (IEL) thickening in ruptured IA (36.3%±15%), while thin and fragmented IEL were common in unruptured IA (5.6%±7.1%). Macrophages were increased in ruptured IA (28.3±24%) versus unruptured IA (2.7%±5.5%), as were leukocytes (12.85%±10% vs 0%). Vasa vasorum in ruptured but not in unruptured IA contained vast numbers of inflammatory cells and extravasation of these cells into the vessel wall. In conclusion, detection of thickened IEL, leaky vasa vasorum, and heavy inflammation as seen in ruptured IA in comparison to unruptured IA may identify aneurysms at risk of rupture, and management strategies preventing development of vasa vasorum or inflammation may reduce the risk of aneurysmal rupture.

Original languageEnglish
Pages (from-to)908-916
Number of pages9
JournalJournal of Neuropathology and Experimental Neurology
Issue number10
Publication statusPublished - 1 Oct 2017
Externally publishedYes


  • Aneurysmal subarachnoid hemorrhage
  • Intracranial aneurysms
  • Ultrastructural analysis


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