Correlative confocal microscopy and ATUM-SEM reveals hallmarks of vascular occlusions and extravasation. (A) Schematic drawing of the ATUM-SEM CLEM workflow. Controlled cortical impact (middle) is followed by systemic injection of 30 nm diameter LNDs (magenta) and 30 nm diameter colloidal gold nanoparticles (black). DyLight 649 lectin (green) was injected 5 min before perfusion (1). After fixation, coronal vibratome sections are generated (2) and positioned onto glass slides with only laying the cover slip on top of the section for confocal imaging (3). The vibratome section is recovered by immersion into the petri dish (4). The previously imaged region of interest is dissected (5) and processed for EM including embedding into resin and contrast enhancement (6). Serial ultramicrotomy and tape collection (7) is followed by wafer mounting and SEM imaging (8). (B) Top: Sum projection of a confocal tile scan (lectin, green; LNDs, magenta; left) and corresponding binocular image (right) of the dissected vibratome section. The lesion area is indicated by a dashed line. Scale bar, 200 µm. Middle: Lesion area identified in the overview tile scan (box in top image) is relocated in the sum projection confocal image and in the serial section low resolution SEM (right). Scale bar, 50 µm. The region of interest (ROI, box) is chosen in the confocal image and re-located in the sum projection SEM image. Bottom: Region of interest confocal image (left) and three single SEM micrographs overlaid with the correlated confocal images (right). Scale bar 5 µm. (C) Scheme of the ATUM-SEM strategy for CLEM. A blood vessel of interest (magenta) in an 80 µm thick vibratome section is relocated by screening serial ultrathin sections at low resolution. The target region is reimaged at high resolution (up to 5x5x50 nm). (D) The correlated region in (B) was segmented and reconstructed from the ultrastructural data. Endothelium (ec, dark green), LNDs and gold particles (Au, magenta), monocyte (mc, orange), neutrophil (np, yellow), platelet (pt, blue), fibrin (fi, grey), erythrocytes (ery, red), pericyte (pc, bright green) are shown. Inset: SEM image of vessel lumen filled with equally sized, putative LNDs (magenta arrowhead) and gold particles (black arrowhead) and bigger aggregates thereof. Scale bar, 100 nm. (E-G) Segmented SEM image (top) and three-dimensional rendering thereof (bottom), scale bars 1 µm, showing (E) the extravasation site from of a neutrophil (yellow), (F) extraluminal gold particles (arrows) next to vessel lumen clotted with platelets (blue) and fibrin (grey) and (G) stalled erythrocytes (red) interspersed with colloidal gold particles. (H) Endothelial morphologies from left to right: normal endothelium (dark green) with tight junction (white arrows) and gold particles (magenta arrows); thinned endothelium covered by a pericyte (bright green), swollen endothelium with mitochondria and tight junction. Immune cells (orange), erythrocytes (red), platelets (blue). Scale bars 1 µm.