• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.89-94
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• 2011

Objective : D-dimer is a breakdown product of fibrin mesh after factor XIII stabilization. Previously, many authors have demonstrated a relationship between D-dimer level and stroke progression or type. This study aimed to investigate the relationship between D-dimer level and stroke volume. Methods : Between January 2008 and December 2009, we analyzed the D-dimer levels of 59 acute ischemic stroke patients in our neurosurgical department both upon admission and after seven days of initial treatment. Each patient's National Institute of Health Stroke Scale score, modified Rankin Scales score, Glasgow outcome score, and infarction volume were also evaluated. Results : Mean D-dimer level at admission was 626.6 ${\mu}g/L$ (range, 77-4,752 ${\mu}g/L$) and the mean level measured after seven days of treatment was 238.3 ${\mu}g/L$ (range, 50-924 ${\mu}g/L$). Mean D-dimer level at admission was 215.3 ${\mu}g/L$ in patients with focal infarctions, 385.7 ${\mu}g/L$ in patients with multiple embolic infarctions, 566.2 ${\mu}g/L$ in those with 1-19 cc infarctions, 668.8 ${\mu}g/L$ in 20-49 cc infarctions, 702.5 ${\mu}g/L$ in 50-199 cc infarctions, and 844.0 ${\mu}g/L$ in >200 cc infarctions (p=0.044). On the 7th day of treatment, the D-dimer levels had fallen to 201.0 ${\mu}g/L$, 293.2 ${\mu}g/L$, 272.0 ${\mu}g/L$, 232.8 ${\mu}g/L$, 336.6 ${\mu}g/L$, and 180.0 ${\mu}g/L$, respectively (p=0.530). Conclusion : Our study shows that D-dimer level has the positive correlation with infarction volume and can be use to predict infarction-volume.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.31-41
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• 2024

Objective : Collateral circulation is associated with the differential treatment effect of endovascular thrombectomy (EVT) in acute ischemic stroke. We aimed to verify the ability of the collateral map to predict futile EVT in patients with acute anterior circulation ischemic stroke. Methods : This secondary analysis of a prospective observational study included data from participants underwent EVT for acute ischemic stroke due to occlusion of the internal carotid artery and/or the middle cerebral artery within 8 hours of symptom onset. Multiple logistic regression analyses were conducted to identify independent predictors of futile recanalization (modified Rankin scale score at 90 days of 4-6 despite of successful reperfusion). Results : In a total of 214 participants, older age (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.56 to 3.67; p<0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR, 1.12; 95% CI, 1.04 to 1.21; p=0.004), very poor collateral perfusion grade (OR, 35.09; 95% CI, 3.50 to 351.33; p=0.002), longer door-to-puncture time (OR, 1.08; 95% CI, 1.02 to 1.14; p=0.009), and failed reperfusion (OR, 3.73; 95% CI, 1.30 to 10.76; p=0.015) were associated with unfavorable functional outcomes. In 184 participants who achieved successful reperfusion, older age (OR, 2.30; 95% CI, 1.44 to 3.67; p<0.001), higher baseline NIHSS scores (OR, 1.12; 95% CI, 1.03 to 1.22; p=0.006), very poor collateral perfusion grade (OR, 4.96; 95% CI, 1.42 to 17.37; p=0.012), and longer door-to-reperfusion time (OR, 1.09; 95% CI, 1.03 to 1.15; p=0.003) were associated with unfavorable functional outcomes. Conclusion : The assessment of collateral perfusion status using the collateral map can predict futile EVT, which may help select ineligible patients for EVT, thereby potentially reducing the rate of futile EVT.

• The Journal of Internal Korean Medicine
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• v.28 no.1
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• pp.92-96
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• 2007

Objectives : This study investigated the clinical effect of a drinking habit in acute stroke patients. Methods : 409 acute stroke patients were included from October 2005 to October 2006. Patients were hospitalized within 14 days after the onset of stroke at DongGuk University International Hospital, Kyungwon University In-cheon Oriental Medical Hospital, or Department of Cardiovascular and Neurologic Diseases (Stroke Center), Kyung Hee University Oriental Hospital. We investigated general characteristics, drinking habit, and stroke subtype by TOAST classification. Results : Among drinking subjects, hemorrhagic stroke was more frequent than ischemic stroke (odds ratio 3.04), and less in small vessel occlusion than others (odds ratio 1.84). Ischemic stroke was associated with a longer (30 yrs) drinking habit than hemorrhagic stroke. Conclusions : To acquire more concrete conclusions on this theme, we need further and larger scale research.

• The Journal of the Society of Stroke on Korean Medicine
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• v.15 no.1
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• pp.29-38
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• 2014

■ Objectives The purpose of this study was to investigate the correlation of The Korean Standard Pattern Identification for Stroke and Intima-Media Thickness of common carotid artery(CCA-IMT). ■ Methods 100 subjects with acute ischemic stroke were recruited from the patients admitted to DongEui Medical Center from the June 2011 to January 2014. We assessed 100 patient's Common Carotid Intima Media Thickness data by B Mode ultrasonography. We investigated pattern identification of all subjects based on Korean Standard Pattern Identification for Stroke-III. then, We analyzed their characteristics, risk factor, blood test result, life style. ■ Results We analyzed indicators of Korean Standard Pattern Identification for Stroke-III by Common Carotid Intima Media Thickness difference. As a result, pale complexion, look powerless, drowsiness like to lie, heat vexation and aversion to heat were significantly higher in the CCAIMT ≧ 1.0mm group then in the CCA-IMT < 1.0mm group. ■ Conclusion According to the analysis, the Relationship between Carotid Intima-Media Thickness and The Korean Standard Pattern Identification for Stroke in Ischemic Stroke Patients were founded. To acquire more concrete conclusion on this theme, we need more research.

• Journal of Korea Multimedia Society
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• v.22 no.5
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• pp.573-579
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• 2019

Alberta Stroke Program Early Computed Tomographic Scoring (ASPECTS) is a 10-point CT-scan score designed to quantify early ischemic changes in patients with acute ischemic stroke. However, an assessment of ASPECTS remains a challenge for neuroradiologists in stroke centers. The purpose of this study is to develop an automated ASPECTS scoring system that provides decision-making support by utilizing binary classification with three-dimensional convolutional neural network to analyze CT images. The proposed method consists of three main steps: slice filtering, contrast enhancement and image classification. The experiments show that the obtained results are very promising.

• Clinical and Experimental Pediatrics
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• v.56 no.9
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• pp.411-415
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• 2013

Infectious diseases precede a significant proportion of acute ischemic strokes in children. Here, we report a case of acute ischemic stroke in a 3-year-old girl with a Mycoplasma pneumonia-associated respiratory tract infection. She developed an acquired prothrombotic state of protein S deficiency and had increased fibrinogen and fibrinogen degradation product levels and increased titer of antinuclear antibodies. However, these conditions were completely alleviated at the 1-month follow-up examination. Infection with M. pneumoniae may cause a transient prothrombotic state that can potentially cause a thrombus.

• Proceedings of the KSMRM Conference
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• 2003.10a
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• pp.98-98
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• 2003

We will present various MR findings of hyperacute ischemic stroke with our own experiences in the management of the patients according to the findings. 대상 및 방법： A total of 441 patients were underwent 'acute stroke MR' imaging protocol between Mar. 2001 and Jun. 2003. The protocol included initial T2-weighted image (WI), diffusion WI (DWI, b=2000), time-of-flight (TOF) MR angiography (MRA), and pefusion WI(PWI), and follow-up T2WI, DWI, TOF MRA, and neck vessel contrast-enhanced MRA obtained three to five days after the insult. Among them, we retrospectively reviewed the MR findings and clinical courses of 193 patients with anterior circulation territorial infarction. Those ICA and MCA lesions were divided into six and five groups respectively according to the level and mechanism of the occlusion. PWI findings can be another factor in the management planning.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.86-92
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• 2018

Background: A delay of transfer for patients with acute stroke needing emergent revascularization is a huge hurdle for efficacy of revascularization. The objective of this study was to investigate changes of transportation time calculated by image to door (ITD) time (from checking brain images at first contact hospital to arriving at our emergency center) before and after 2015. Methods: This study was performed in a retrospective manner from 2013 into 2017. Acute ischemic stroke (AIS) patients having intravenous thrombolysis and/or mechanical thrombectomy during the observation period were enrolled. Among them, those who had revascularization under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm were selected. Results: During the observation period, 225 patients were treated under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm. Twenty-three were excluded due the lack of detailed data. Among 202 patients, 73 and 129 were treated under Drip-and-Ship and Ship-and-Drip paradigms, respectively. In 2013, 35 patients from 18 hospitals (median distance, 25 km) were transferred to our regional stroke center and their median ITD time was 116 minutes. It was gradually decreased after 2015. In 2017, ITD time was significantly (P<0.01) shortened to 85 minutes without significant changes in transfer distance. The median onset to puncture time was also significantly (P=0.03) decreased from 365 minutes in 2013 to 270 minutes in 2017. Conclusion: Our results implicate that many hospitals in our stroke region might have recognized the importance of rapid transportation for AIS after 2015.

• Health Policy and Management
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• v.33 no.4
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• pp.440-449
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• 2023

Background: This study aimed to analyze the prehospital process and reperfusion therapy process of acute ischemic stroke in Busan metropolitan area and examine the impact of living arrangement on the early management and functional outcomes of acute ischemic stroke (AIS). Methods: The patients who diagnosed with AIS and received reperfusion therapy at the Busan Regional Cardiovascular Center between September 2020 and May 2023 were selected. We investigated the patients' hospital arrival time (onset to door time) and utilization of 119 emergency ambulance services. Additionally, various time matrices related to reperfusion therapy after hospital were examined, along with the functional outcome at the 90-day after treatment. Results: Among the 753 AIS patients who underwent reperfusion therapy, 166 individuals (22.1%) were living alone. AIS patients living alone experienced significant delays in symptom detection (p<0.05) and hospital arrival compared to AIS patients with cohabitants (370.1 minutes vs. 210.2 minutes, p<0.001). There were no significant differences between the two groups in terms of 119 ambulance utilization and time metrics related with the reperfusion therapy. Independent predictors of prognosis in AIS patients were found to be age above 70, National Institutes of Health Stroke Scale score at admission, tissue plasminogen activator, living alone (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.155-2.760) and interhospital transfer (OR, 1.898; 95% CI, 1.152-3.127). Delay in identification of AIS was shown significant correlation (OR, 2.440; 95% CI, 1.070-5.561) at living alone patients. Conclusion: This study revealed that AIS patients living alone in the Busan metropolitan region, requiring endovascular treatment, face challenges in the pre-hospital phase, which significantly impact their prognosis.

• Journal of Korean Neurosurgical Society
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• v.60 no.3
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• pp.335-347
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• 2017

Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays. Huge progress was made in 2015, as there were five randomized clinical trials which all demonstrated the safety and efficacy of endovascular stroke treatment. Despite differences in detail patient enrollment criteria, all 5 trials employed key factors for good functional recovery; (1) screening with non-invasive imaging to identify the proximal occlusion and exclude a large infarct core, (2) using highly effective modern thrombectomy devices mainly with stent retriever, and (3) establishment of a fast workflow to achieve effective reperfusion. The results of those trials indicate that modern thrombectomy devices can allow for faster and more effective reperfusion, which can lead to improved clinical outcomes compared to intravenous thrombolysis alone. These advances in mechanical thrombectomy are promising in the global fight against ischemic stroke-related disability and mortality. Two current mainstreams among such mechanical thrombectomy techniques, "stent retriever thrombectomy" and "direct clot aspiration", are the topic of this review. Stent retriever thrombectomy using Solitaire and Trevo retriever will be firstly discussed. And, the commonalities and the differences between two major clot aspiration thrombectomy techniques; a direct aspiration first pass technique (ADAPT) and forced arterial suction thrombectomy (FAST), will be additionally explained. Finally, details regarding the combination of direct clot aspiration and stent retriever thrombectomy, the switching strategy and the Solumbra technique, will be described.