Segmental arterial mediolysis with mesangial cell hyperplasia; A review with supplementary comments concerning its pathogenesis

Slavin, Richard E.; Leifsson, Páll S.

doi:10.4172/interventional-cardiology.1000576

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…(3) SAM's rapid development, an inherent characteristic of the autonomic nervous system, following the iatrogenic administration of alpha-1 adrenoreceptor agonists and beta-2 agonists capable of releasing norepinephrine from the peripheral sympathetic nervous system [6] (4) SAM's occurrence in clinical conditions of extreme stress that could provoke the release of supraphysiologic levels of norepinephrine from the adrenal medulla [7] (5) The occurrence of renal artery lesions in patients with pheochromocytomas identical to those created in reparative-phase SAM [8] 2.2. Injurious-Phase SAM.…”

Section: Methodsmentioning

confidence: 99%

Segmental Arterial Mediolysis: A Multiguised Vasospastic Arteriopathy with Collateral Mesangial Cell Hyperplasia and Cardiac Toxicity Generated by Norepinephrine and Hyperdense Adrenoceptors Alone or by Crosstalk with Other Pressor Agents

Slavin¹

2021

International Journal of Vascular Medicine

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Segmental arterial mediolysis (SAM), an uncommon vasospastic arteriopathy occurring in the muscular arteries innervated by the peripheral sympathetic nervous system, usually presents with catastrophic abdominal and retroperitoneal hemorrhages in elderly patients. SAM is initiated by the coupling of norepinephrine to plastically derived hyperdense foci of alpha-1 adrenergic receptors on the sarcolemma of arterial muscle. This ligand is created by stimuli signaled by iatrogenic sympathomimetic agonists, some beta-2 agonists, or an excessive release of adrenal catecholamines. Coupling of this ligand with cytoplasmic heterotrimeric Gq protein excessively signals a cascade of biochemical events generating two principal lesions of injurious-phase SAM—the shearing of the outer media from the adventitia and an overload of cytoplasmic calcium ions toxic to mitochondria causing mediolysis and/or apoptosis. The massive hemorrhages are caused by ruptured gap aneurysms created by the transmedial loss of the medial muscle. A norepinephrine-directed reparative response rapidly develops either resolving angiographic injurious lesions or creating a body of vascular disorders, the new guises of SAM with ischemic clinical profiles. These present in the epicardial, vertebral, intestinal, and retroperitoneal arteries, often in younger females as fibromuscular dysplasia, dissecting hematomas, and persistent aneurysms. Norepinephrine can crosstalk with other pressor agents to create SAM lesions—serotonin with idiopathic pulmonary hypertension and persistent pulmonary hypertension in the newborn, histamine in spontaneous coronary artery dissections with eosinophilia, and endothelin-1 in a field effect generated by SAM that creates venous fibromuscular dysplasia. Norepinephrine also participates in the collateral development of mesangial hyperplasia with focal segmental glomerulosclerosis and myocardial mediolysis and apoptosis in subjects with markedly elevated heart rates. Conclusion. Norepinephrine coupling with plastically elevated alpha-1 adrenoceptor or other pressor agents generates SAM, a histologically recognizable vasospastic arteriopathy, that with repair is transformed into several different standardized arterial diseases that alter SAM’s clinical profile from a hemorrhagic to an ischemic disorder.

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Section: Methodsmentioning

confidence: 99%

Segmental Arterial Mediolysis: A Multiguised Vasospastic Arteriopathy with Collateral Mesangial Cell Hyperplasia and Cardiac Toxicity Generated by Norepinephrine and Hyperdense Adrenoceptors Alone or by Crosstalk with Other Pressor Agents

Slavin¹

2021

International Journal of Vascular Medicine

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“…The medial smooth muscle layer revealed segmental necrosis, typically causing intraabdominal hemorrhaging. In an animal model, α1 or β2 adrenergic agonists accelerated the release of noradrenaline from the sympathetic nerve, which induced the apoptosis of smooth muscle cells of the tunica media ( 25 , 26 ). The outer arterial medial layer resulted in vacuolization and lysis, representative microscopic features of SAM.…”

Section: Discussionmentioning

confidence: 99%

Acalculous Ischemic Cholecystitis Caused by Spontaneous Celiac Artery Dissection

et al. 2022

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We herein report a case of spontaneous isolated dissection of the celiac artery. A Japanese man in his 50s visited an emergency unit, complaining of sudden epigastralgia. Contrast-enhanced computed tomography indicated dissection of the celiac artery with patent false and true lumina, extending to the splenic and common hepatic arteries. On day 3 of hospitalization, the dissection progressed to the proper and right hepatic arteries. Progression of the dissection to the right hepatic artery provoked acalculous ischemic cholecystitis, and cholecystectomy followed. The resected gallbladder revealed extensive aseptic necrosis with little inflammatory reaction, and the gallbladder neck was spared from ischemia.

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“…In addition to humans, SAM is also prevalent in dogs and pigs; in these animals, SAM is accompanied by mesangial cell hyperplasia. Slavin and Leifsson [1] investigated the relationship between SAM and mesangial hyperplasia. The authors found that the various stimuli at the root of SAM may also induce focal mesangial cell hyperplasia and contraction; thus, it can be inferred that SAM and mesangial cell hyperplasia have a shared pathogenesis.…”

Section: Introductionmentioning

confidence: 99%

“…Slavin and Leifsson [1] investigated the relationship between Segmental arterial mediolysis (SAM) and mesangial hyperplasia. Roever et al [2], investigated the prevalence of atherosclerosis risk factors and Metabolic syndrome (MetS) in urban Brazilian population.…”

Section: Introductionmentioning

confidence: 99%

Interventional cardiology

Avula¹

2017

Interventional-Cardiology.

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Segmental arterial mediolysis with mesangial cell hyperplasia; A review with supplementary comments concerning its pathogenesis

Cited by 3 publications

References 15 publications

Segmental Arterial Mediolysis: A Multiguised Vasospastic Arteriopathy with Collateral Mesangial Cell Hyperplasia and Cardiac Toxicity Generated by Norepinephrine and Hyperdense Adrenoceptors Alone or by Crosstalk with Other Pressor Agents

Segmental Arterial Mediolysis: A Multiguised Vasospastic Arteriopathy with Collateral Mesangial Cell Hyperplasia and Cardiac Toxicity Generated by Norepinephrine and Hyperdense Adrenoceptors Alone or by Crosstalk with Other Pressor Agents

Acalculous Ischemic Cholecystitis Caused by Spontaneous Celiac Artery Dissection

Interventional cardiology

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