Histological differences of the Vascular wall between sites with high and low prevalence of intracranial aneurysm

Intracranial aneurysms (IAs) develop more often on bifurcations compared with the rest of the circle ofWillis (CoW). We investigated histological differences between 2 high IA prevalence sites (anterior communicating artery [AcomA] and basilar tip) and 2 corresponding low IA prevalence sites (anterior cerebral artery [ACA] and basilar artery [BA]) using histological sections of 10 CoWs without IAs. Medial defect density in the AcomA was 0.24 medial defects/mm compared with 0.02 for the A1 part and 0.03 for the A2 part of the ACA. In the basilar tip we found 0.15 medial defects/mm compared with 0.14 in the BA. Vascular smooth muscle cells (VSMCs) were more often disorganized in both high-prevalence sites (AcomA: 10/ 10, basilar tip: 5/10) compared with low-prevalence sites (both ACA and BA: 1/10). Intima thickening was more severe in the highprevalence sites. Vascular wall thickness was not significantly different between high- and low-prevalence sites, but had a larger variance in high- compared with low-prevalence sites (AcomA vs ACA: p=6.8E-12, basilar tip vs BA: p=0.02). Disorganized VSMCs at high-prevalence sites likely result in a higher susceptibility to hemodynamic stress, leading to more vascular remodeling (such as intima thickening), which could increase the likelihood of IA formation.