Correlation of Adventitial Vasa Vasorum with Intracranial Atherosclerosis: A Postmortem Study

Abstract

Background and PurposeVasa vasorum (VV) have been believed to be rare or non-existent in small-caliber intracranial arteries. In a series of human cerebral artery specimens, we identified and examined the distribution of VV in association with co-existing intracranial atherosclerosis. MethodsWe obtained cerebral artery specimens from 32 consecutive autopsies of subjects aged 45 years or above. We scrutinized middle cerebral artery (MCA), vertebral artery (VA), and basilar artery (BA) for the presence of adventitial VV. We described the distribution of VV, and the characteristics of co-existing atherosclerotic lesions. ResultsAmong 157 intracranial arteries, adventitial VV were present in 74 of the 157 specimens (47%), involving MCA (n=13, 18%), BA (n=14, 19%), and VA (n=47, 64%). Although qualitatively these 74 adventitial VV distributed similarly in arteries with or without atherosclerotic lesions (disease-free arteries n=4/8; arteries of pre-atherosclerosis n=17/42; and arteries of progressive atherosclerosis n=53/107), the presence of adventitial VV in intracranial VA was associated with a heavier plaque load (1.72±1.66 mm2 vs. 0.40±0.32 mm2, P<0.001), severer luminal stenosis (25%±21% vs. 12%±9%, P=0.002), higher rate of concentric lesions (79% vs. 36%, P=0.002), and denser intraplaque calcification (44% vs. 0%, P=0.003). Histologically, intracranial VA with VV had a larger diameter (3.40±0.79 mm vs. 2.34±0.58 mm, P<0.001), thicker arterial wall (0.31±0.13 mm vs. 0.23±0.06 mm, P=0.002), and a larger intima-media (0.19±0.09 mm vs. 0.13± 0.04 mm, P=0.003) than VA without VV. ConclusionsOur study demonstrated the distribution of adventitial VV within brain vasculature and association between vertebral VV and progressive atherosclerotic lesions with a heavier plaque load and denser intraplaque calcification.

Comparison of symptomatic vertebrobasilar plaques between patients with and without Diabetes Mellitus using computed tomographic angiography and vessel wall magnetic resonance imaging

“…Increased contrast wash-in could be expected as endothelium deficiency after symptoms presentation and greater vasa vasorum density in the vertebrobasilar artery. 34 Calcification exhibited a negative correlation with the entry and delivery of contrast agents into the plaque as validated by histology. 35 Limitations of this study need to be considered.…”

Vasa vasorum of proximal cerebral arteries after dural crossing — potential imaging confounder in diagnosing intracranial vasculitis in elderly subjects on black-blood MRI

“…Particularly in the elderly patient population that often suffers from increased vascular comorbidities, there are frequently additional atherosclerotic vessel wall changes that might cause difficulties in the interpretation [2,9]. Moreover, it can be assumed that the presence of vasa vasorum is associated with the progression of atherosclerosis [7,21]. While vasculitic affection and VWE caused by the presence of vasa vasorum usually manifest as smooth concentric lesions, atherosclerotic vessel wall lesions typically show an eccentric plaque-like configuration [9].…”

“…Another histopathologic study examined 30 human autopsy materials and found vasa vasorum in the proximal 1–2 cm of all VA and ICA [ 22 ], comparable to our imaging results. Another histopathologic study demonstrated that vasa vasorum were found in nearly half of all examined arteries with a significant higher prevalence in the VA compared to the basilar artery or the middle cerebral artery as well as a correlation between the existence and amount of vasa vasorum and the atherosclerotic disease burden in the VA [ 21 ].…”

Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease

“…Vasa vasorum is a microvasculature network in vessel walls that delivers oxygen and nutrition (29) and transports inflammatory mediators (30)(31)(32) that could contribute to atherosclerosis. In 2018, Zheng et al (33) first reported the association between the density of intraplaque calcification and the presence of adventitial vasa vasorum in ex vivo VA specimens, indicating a mutual basis of calcification and ICAS. However, whether intimal or medial calcification is associated with vasa vasorum is yet unknown.…”