Collagen type III deficiency in patients with rupture of intracranial saccular aneurysms

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✓ Samples of the middle cerebral artery (MCA) and the brachial artery were obtained post mortem from 14 patients who died following rupture of intracranial saccular aneurysms and from a control group of 14 age- and sex-matched patients who died of causes unrelated to aneurysm rupture. The biomechanical properties of ring-shaped arterial specimens were investigated by loading the specimens at a constant deformation rate until rupture. The relative amounts of collagen type I and type III were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) studies of cyanogen bromide peptides of collagen prepared from the arterial samples. A deficiency of collagen type III was demonstrated in specimens of the MCA in six of 14 patients with a ruptured intracranial saccular aneurysm. This deficiency was not accompanied by alterations in the mechanical arterial strength but resulted in a significant increase in the extensibility at stress values corresponding to blood pressures between 100 and 200 mm Hg. No difference was found between aneurysm patients and the control group in regard to the biomechanical properties of the brachial artery, despite the presence of a significant deficiency of collagen type III. The increase in vascular extensibility of the MCA may represent alterations in the fibrous structure and functional integrity of the cerebral arteries of aneurysm patients with collagen type III deficiency. Together with aggravating hemodynamic stresses, this deficiency may be an important factor in the pathogenesis of saccular aneurysms.

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Address reprint requests to: John R. Østergaard, M.D., Department of Neurosurgery GS, Aarhus Kommunehospital, DK-8000 Aarhus C, Denmark.

© AANS, except where prohibited by US copyright law.

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Figures

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    Load-strain (left) and stress-strain (right) diagrams for specimens of the middle cerebral artery from patients with ruptured intracranial saccular aneurysms and deficiency of collagen type III (solid lines), from patients with rupture of aneurysms and no deficiency of collagen type III (dotted dashed lines), and from a control group comprising 14 individuals who died of causes unrelated to saccular aneurysms (broken lines). The regions of the curves corresponding to blood pressures of 100 and 200 mm Hg are marked by horizontal broken lines. N = newton. Standard errors of the means are marked by bars. * = p < 0.05 when compared to aneurysm patients without deficiency of collagen type III, and p < 0.01 when compared to the control group. ** = p < 0.02 when compared to aneurysm patients without deficiency of collagen type III, and p < 0.01 when compared to the control group.

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    Wall thickness and internal diameter (mm) of the middle cerebral artery of aneurysm patients and control patients. Group A comprised aneurysm patients with a collagen type I:type III ratio exceeding the mean value + 2 standard deviations (SD's) of the control group. In Group B the collagen type I:type III ratios were all below the mean value + 2 SD's of the control group. § = p < 0.05 when compared to the controls. No = case number; N = number of patients.

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    Load-strain (left) and stress-strain (right) diagrams for specimens of the brachial artery from patients with ruptured intracranial saccular aneurysms and deficiency of collagen type III (solid lines) and the control group (broken lines). The regions of the curves corresponding to blood pressures of 100 and 200 mm Hg are marked by horizontal broken lines. N = newton. Standard errors of the mean are marked by bars.

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    Correlation between the collagen type I:type III ratios of the middle cerebral artery and the brachial artery in patients dying of causes unrelated to aneurysm rupture (left) and in aneurysm patients with collagen type III deficiency (right). The correlation shown at left is not significant, whereas the correlation shown at right is significant (r = 0.91, p < 0.01). Each dot indicates a patient.

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