Constrictive Endarteropathy Following Experimental Subarachnoid Hemorrhage

Rhesus monkeys were subjected to subarachnoid hemorrhage by either the introduction of blood into the subarachnoid space or by mechanically rupturing the middle cerebral artery. Local cerebral blood flow, vascular compliance studies, and histological studies (light and electron microscope) were made of the vessels of all animals. In animals hemorrhaged via vascular rupture, subintimal swelling and thickening was minimally present by 3 days, becoming progressively more severe by one month. Such changes consisted of severe subintimal proliferation, fibrosis of the medial smooth muscle layer and interruption of the internal elastic membrane. Cells in the subintimal proliferative areas examined by electronmicroscopy were seen to have ultrastructural characteristics of smooth muscle. In the subarachnoid-injected hemorrhaged animals, there was no evidence of intimal proliferation or other vascular changes, which was also true of all control vessels. There was a decrease in wall elasticity of vessels exposed to mechanical rupture when compared to those exposed only to injected subarachnoid blood or normal vessels. Local cerebral blood flow was affected very little following the 2 methods of subarachnoid hemorrhage.