• Title/Summary/Keyword: COILING

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Benefits of Surgical Treatment for Unruptured Intracranial Aneurysms in Elderly Patients

  • Jang, E-Wook;Jung, Jin-Young;Hong, Chang-Ki;Joo, Jin-Yang
    • Journal of Korean Neurosurgical Society
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    • v.49 no.1
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    • pp.20-25
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    • 2011
  • Objective: Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients. Methods: We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients: age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups: Group A (surgical clipping), Group B (coil embolization), and Group C (observation only). Results: Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for Clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. Conclusion: Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients, In the treatment of patients more than 65 years old, age is not the limiting factor.

Thromboembolic Events Associated with Electrolytic Detachment of Guglielmi Detachable Coils and Target Coils : Comparison with Use of Diffusion-Weighted MR Imaging

  • Kim, Myeong Jin;Lim, Yong Cheol;Oh, Se-Yang;Kim, Byung Moon;Kim, Bum-Soo;Shin, Yong Sam
    • Journal of Korean Neurosurgical Society
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    • v.54 no.1
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    • pp.19-24
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    • 2013
  • Objective : The purpose of this study was to retrospectively evaluate and compare the incidence of diffusion-weighted image (DWI) lesions between the Guglielmi detachable coil (GDC) and the Target coil for treating unruptured intracranial aneurysm. Methods : From 2010 to 2011, consecutive 222 patients with an intracranial aneurysm underwent coil embolization. Inclusion criterias were : 1) unruptured intracranial aneurysm, 2) one or more GDC or Target coils used with or without other coils, 3) DWI examination within 24 hours after coiling, and 4) coiling performed without a balloon or stent. Results : Ninety patients (92 cases) met the inclusion criteria. DWI lesions were detected in 55 (61.1%) of 90 patients. In the GDC group (n=44), DWI lesions were detected in 31 (70.5%). The average number of DWI lesions was $5.0{\pm}8.7$ (mean${\pm}$SD; range, 1-40) in aneurysm-related territory. In the Target coil group (n=48), DWI lesions were detected in 24 (50.0%). The number of DWI lesion was $2.1{\pm}5.4$ (range, 1-32) in aneurysm-related territory. There was no significant correlation between a number of coils and DWI lesions. No significant differences were also observed in the number of DWI lesions in each group. Conclusion : The GDC and Target coils, which have an electrolytic detachable system, showed no differences in the incidence of DWI lesion.

Comparison of Endovascular Treatments of Ruptured Dissecting Aneurysms of the Intracranial Internal Carotid Artery and Vertebral Artery with a Review of the Literature

  • Byoun, Hyoung Soo;Yi, Hyeong Joong;Choi, Kyu Sun;Chun, Hyoung Joon;Ko, Yong;Bak, Koang Hum
    • Journal of Korean Neurosurgical Society
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    • v.59 no.5
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    • pp.449-457
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    • 2016
  • Objective : Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. Methods : The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. Results : Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. Conclusion : Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.

Effect of Coiling Temperature and Alloying Elements on the Mechanical Properties and Precipitation Behavior in High Strength Hot Rolled Steel Sheets (고강도 열연강판의 기계적 성질과 석출거동에 미치는 권취온도와 합금원소의 영향)

  • Kang, S.S.;Lee, O.Y.;Han, S.H.;Jin, K.G.;Seong, B.S.
    • Korean Journal of Materials Research
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    • v.13 no.10
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    • pp.683-690
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    • 2003
  • The high strength low alloy(HSLA) steels microalloyed with Nb, Ti and V have been widely used as the automobile parts to decrease weight of vehicles. The effects of process conditions are investigated in the aspects of the precipitation behavior and the mechanical properties of HSLA steel microalloyed with Nb and Ti using TEM, SANS and mechanical testing. When Ti was added to a 0.07C-1.7Mn steel which was coiled at $500^{\circ}C$, the specimen revealed the property of higher tensile strength of 853.1 MPa and the stretch-flangeability of 60%. The stretch-flangeability was increased up to 97.8% for coiling temperature above $700^{\circ}C$. The precipitation hardening cannot be achieved in the 0.045C-1.65Mn steel which was the lower density of fine precipitates. However, the 0.07C-1.7Mn steels containing Nb and/or Ti which was coiled at X$/^{\circ}C$ have a high precipitates density of $2${\times}$10^{ 5}$/$\mu$㎥. The high strength of these steels was attributed to the precipitation hardening caused by a large volume froction of (Ti, Nb)C precipitates with a size below 5 nm in ferrite matrix.

Reappraisal of Anatomic Outcome Scales of Coiled Intracranial Aneurysms in the Prediction of Recanalization

  • Lee, Jong Young;Kwon, Bae Ju;Cho, Young Dae;Kang, Hyun-Seung;Han, Moon Hee
    • Journal of Korean Neurosurgical Society
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    • v.53 no.6
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    • pp.342-348
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    • 2013
  • Objective : Several scales are currently used to assess occlusion rates of coiled cerebral aneurysms. This study compared these scales as predictors of recanalization. Methods : Clinical data of 827 patients harboring 901 aneurysms treated by coiling were retrospectively reviewed. Occlusion rates were assessed using angiographic grading scale (AGS), two-dimensional percent occlusion (2DPO), and volumetric packing density (vPD). Every scale had 3 categories. Followed patients were dichotomized into either presence or absence of recanalization. Kaplan-Meier analysis was conducted, and Cox proportional hazards analysis was performed to identify surviving probabilities of recanalization. Lastly, the predictive accuracies of three different scales were measured via Harrell's C index. Results : The cumulative risk of recanalization was 7% at 12-month, 10% at 24-month, and 13% at 36-month of postembolization, and significantly higher for the second and third categories of every scale (p<0.001). Multivariate-adjusted hazard ratios (HRs) of the second and third categories as compared with the first category of AGS (HR : 3.95 and 4.15, p=0.004 and 0.001) and 2DPO (HR : 4.87 and 3.12, p<0.001 and 0.01) were similar. For vPD, there was no association between occlusion rates and recanalization. The validated and optimism-adjusted C-indices were 0.50 [confidence (CI) : -1.09-2.09], 0.47 (CI : -1.10-2.09) and 0.44 (CI : -1.10-2.08) for AGS, 2DPO, and vPD, respectively. Conclusion : Total occlusion should be reasonably tried in coiling to maximize the benefit of the treatment. AGS may be the best to predict recanalization, whereas vPD should not be used alone.

Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms

  • Choi, Jae Young;Choi, Chang Hwa;Ko, Jun Kyeung;Lee, Jae Il;Huh, Chae Wook;Lee, Tae Hong
    • Journal of Yeungnam Medical Science
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    • v.36 no.3
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    • pp.208-218
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    • 2019
  • Background: The anatomy of middle cerebral artery (MCA) aneurysms has been noted to be unfavorable for endovascular treatment. The purpose of this study was to assess the feasibility and efficacy of coiling for MCA aneurysms. Methods: From January 2004 to December 2015, 72 MCA aneurysms (38 unruptured and 34 ruptured) in 67 patients were treated with coils. Treatment-related complications, clinical outcomes, and immediate and follow-up angiographic outcomes were retrospectively analyzed. Results: Aneurysms were located at the MCA bifurcation (n=60), 1st segment (M1, n=8), and 2nd segment (M2, n=4). Sixty-nine aneurysms (95.8%) were treated by neck remodeling techniques using multi-catheter (n=44), balloon (n=14), stent (n=8), or combination of these (n=3). Only 3 aneurysms were treated by single-catheter technique. Angiographic results were 66 (91.7%) complete, 5 (6.9%) remnant neck, and 1 (1.4%) incomplete occlusion. Procedural complications included aneurysm rupture (n=1), asymptomatic coil migration to the distal vessel (n=1), and acute thromboembolism (n=10) consisting of 8 asymptomatic and 2 symptomatic events. Treatment-related permanent morbidity and mortality rates were 4.5% and 3.0%, respectively. There was no bleeding on clinical follow-up (mean, 29 months; range, 6-108 months). Follow-up angiographic results (mean, 26 months; range, 6-96 months) in patients included 1 major and 3 minor recanalizations. Conclusion: Coiling of MCA aneurysms could be a technically feasible and clinically effective treatment strategy with acceptable angiographic and clinical outcomes. However, the safety and efficacy of this technique as compared to surgical clipping remains to be ascertained.

Simulation of underwater echo reduction using miniaturized Helmholtz resonators (소형화된 헬름홀츠 공진기를 이용한 수중 반향음 감소해석 모의실험)

  • Park, SungJun;Kim, Jedo
    • The Journal of the Acoustical Society of Korea
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    • v.38 no.1
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    • pp.67-72
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    • 2019
  • In this study, we investigate the echo reduction performance of miniaturinzed Helmholtz resonators using smaller than wavelength acoustic metamaterial structures. The Helmholtz resonators are formed using air structures which exhibit large impedance mismatch with the surrounding underwater environment. Using the multi-physics software package, we find that significant reduction in the sonar signature is expected and frequency tailoring is possible by controlling the degree of space coiling and inner volume of the resonators. We find that for the basic Helmholtz resonators, up to 7 dB reduction in echo is expected at 10,000 Hz while when the miniaturized Helmoholtz resonators are used, up to 14 dB reduction in echo is expected at 5,000 Hz. In addition, frequency tailoring is demonstrated by varying the internal volume of the Helmholtz resonators and broadband characteristic is shown using superposition of various degree of space coiled structures. Through this study we investigate the effectiveness of the miniaturized Helmholtz resonators formed using air structures and the echo reduction results show promisses in the application of achieving underwater stealth.

Outcomes of Stent-Assisted Coiling Using the Neuroform Atlas Stent in Unruptured Wide-Necked Intracranial Aneurysms

  • Kwon, Ohyuk;Chung, Joonho
    • Journal of Korean Neurosurgical Society
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    • v.64 no.1
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    • pp.23-29
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    • 2021
  • Objective : Although stent-assisted coiling (SAC) has been reported to be safe and effective in treating wide-necked aneurysms, the technique has procedure-related complications. Thus, we reported our experiences of SAC using the Neuroform Atlas stent in treating wide-necked aneurysms and evaluated the incidence of and risk factors for procedure-related complications. Methods : From March 2018 to August 2019, we treated 130 unruptured wide-necked aneurysms in 123 patients with Neuroform Atlas stents. Angiographic results and clinical outcomes were reviewed retrospectively. Clinical and angiographic follow-up were performed in all cases (mean, 12.4 months) after the procedure. Results : There were eight cases (6.2%) of procedure-related complications (two dissections, five thromboembolisms, and one hemorrhage) and two (1.5%) of delayed complications (one ischemia and one hemorrhage). There was one case (0.8%) of failure of stent deployment and one (0.8%) of suboptimal positioning of the stent. Follow-up angiography showed complete obliteration in 103 (79.2%), residual neck in 16 (12.3%), and residual aneurysm in 11 cases (8.5%). Aneurysm locations in the middle cerebral artery (odds ratio [OR], 2.211; p=0.046) and the anterior communicating artery (OR, 2.850; p=0.039) were associated with procedure-related complications on univariate analysis. However, no independent risk factor for procedure-related complications was noted in multivariate analysis. Conclusion : The Neuroform Atlas showed a high rate of technical success. Good clinical and radiographic outcomes in early follow-up suggests that the device is feasible and safe. SAC of aneurysms on the middle cerebral artery or anterior communicating artery may require more attention to prevent possible procedure-related complications.

Morphological Characteristics of Prymnesium patelliferum Green, Hibberd and Pienaar (Haptophyta) from Korea (Prymnesium patelliferum Green, Hibberd and Pienaar (Haptophyta)의 형태 특성 고찰)

  • Kim, Hyeung-Sin;Jung, Min-Min
    • ALGAE
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    • v.19 no.3
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    • pp.277-282
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    • 2004
  • Prymnesium patelliferum was collected from Hwajinpo, South Korea in November 2002. This is the first record of P. patelliferum in Korea waters. The characteristic shape of P. patelliferum was that of a rice grain. Cells were sub spherical or elongate, and sometimes slightly compressed. The motile cells of P. patelliferum (8-10 ㎛ long, 5-6 ㎛ broad) prossessed two equal or sub equal flagella(10.5-13 ㎛) and a short non-coiling haptonema (3-5 ㎛). The cell was covered by two layers of organic scales, which were important taxonomic characteristics. Internal scales were a narrow inflexed rim on the distal face, a thickening central and radial fibrillar pattern. External scales were very similar to internal scales with relatively tall upright rims. The ridges were in quadrants with 11-12 ridges per quadrant.

Annotated List of the Korean Triphoridae (Gastropoda), with a New Record of Mastonia rubra

  • Lee, Yucheol;Shin, Youngheon;Park, Jina;Park, Joong-Ki
    • Animal Systematics, Evolution and Diversity
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    • v.34 no.3
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    • pp.168-173
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    • 2018
  • The family Triphoridae Gray, 1847 is a group of marine microgastropods characterized by sinistral (left-coiled) shells except for the subfamily Metaciinae, which has dextral shell coiling. We report a new record of Mastonia rubra (Hinds, 1843) collected from the intertidal zone from Jeju Island, Korea and revise species list for Korean Triphoridae species. Mastonia rubra is distinguished from Inforis fusiformis(Kosuge, 1961) by the purple color of the first and second whorls of the teleoconch, whereas they are light colored and nearly white corresponding whorls in I. fusiformis. Including this new record, the Korean Triphoridae comprises 20 species from 15 genera.