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Lectin-like oxidized low-density lipoprotein receptor 1 and matrix metalloproteinase expression in ruptured and unruptured multiple dissections of distal middle cerebral artery: case report

  • Case Report
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Acta Neurochirurgica Aims and scope

Abstract

Purpose

Oxidized low-density lipoprotein receptor 1 (LOX1) is a critical factor for atherosclerosis in a variety of vascular diseases; however, its major role in cerebral arterial dissecting aneurysm is unclear.

Clinical presentation

We present a case of remarkable contrast of LOX1 expression in ruptured and unruptured multiple middle cerebral artery dissections and discuss the correlation of LOX1 with matrix metalloproteinases (MMPs). A 59-year-old woman presented with subarachnoid hemorrhage associated with left temporal subcortical hematoma. Emergent cerebral angiography demonstrated aneurysmal dilatation at the origin of the left anterior temporal artery (ATA) and occlusion on the distal side of ATA. Infectious aneurysm was excluded. Intraoperative findings showed ruptured dissection of the left ATA and unruptured aneurysmal dilatation of another temporal branch of the left M1 portion. Both lesions were trapped by clips and resected. Histopathological examination confirmed that both ruptured and unruptured aneurysmal dilatations were diagnosed as arterial dissections. Immunohistochemical examination demonstrated remarkable expressions of LOX1, MMP-2, and MMP-9 in hypertrophic media outside the intima in ruptured dissection, on the other hand, those expressions in the intima and inside hypertrophic media in the unruptured dissection.

Conclusions

This is the first report to reveal immunohistochemical findings of LOX1 and MMPs in multiple dissections of MCA. The contrast localization of LOX1 and MMPs might contribute to the fragility of the arterial wall layer of ruptured/unruptured arterial dissections.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba, Sendai, Miyagi, 980-8574, Japan

    Atsushi Saito, Hiroaki Shimizu & Teiji Tominaga

  2. Department of Neurosurgery, Konan Hospital, 4-20-1 Nagamachiminami, Taihaku, Sendai, 9820011, Japan

    Miki Fujimura & Takashi Inoue

Authors
  1. Atsushi Saito
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  2. Miki Fujimura
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  3. Takashi Inoue
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  4. Hiroaki Shimizu
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  5. Teiji Tominaga
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Corresponding author

Correspondence to Atsushi Saito.

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Comment

The case reported is a very interesting and well-documented. Moreover, the authors provide a well-written introduction as to why the case described would be an interesting one and why they performed the immunohistochemical studies described. Furthermore, the discussion of the case and its histological presentation include interesting speculations that might have broader implications to other types of intracranial aneurysms and their etiology which still remains to be elucidated.

Juhana Frösen

Mika Niemelä

Juha Hernesniemi

Helsinki, Finland

This well-written report is interesting for many aspects:

1. The relative rarity of arterial dissections in the anterior circulation, particularly when MCA is affected. The involvement of the M3 portion is even rarer, exceptional when the dissecting aneurysm is localized on multiple temporal branches of MCA.

2. The unusual and clearly depicted intraoperative illustration that the unruptured lesion dilated after surgical manipulation with the penetration of blood flow and progression of arterial dissection.

3. The novel observation that immunohistochemical findings of LOX1 and MMP immunoreactivities were observed in the hypertrophic collagenous layer of the dissecting arterial wall in the ruptured dissection and in the hypertrophic intimal layer in the unruptured dissection.

Although an intriguing theory, at the present stage, the contribution of different localization of LOX1 and MMPs to the fragility of the arterial wall layer of ruptured/unruptured arterial dissections can be discussed only on a conjectural basis, and much more observations are needed before one can advance a robust pathophysiological interpretation.

Domenico d'Avella

Padova, Italy

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Saito, A., Fujimura, M., Inoue, T. et al. Lectin-like oxidized low-density lipoprotein receptor 1 and matrix metalloproteinase expression in ruptured and unruptured multiple dissections of distal middle cerebral artery: case report. Acta Neurochir 152, 1235–1240 (2010). https://doi.org/10.1007/s00701-009-0560-6

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  • DOI: https://doi.org/10.1007/s00701-009-0560-6

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