• Journal of Korean Neurosurgical Society
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• 제46권6호
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• pp.572-576
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• 2009

Detachable balloon-based endovascular fistula occlusion is a widely accepted treatment for traumatic carotid cavernous fistulas (CCF). However, more recently coils have been used to obliterate the lesion, especially in case detachable balloon is not available. We failed balloon-assisted coil embolization for CCF because of large fistulas and herniation of coil loops into the parent artery. The authors describe our experiences of balloon-expandable graft-stents to treat CCF, and place emphasis on arterial wall reconstruction. Three traumatic CCF patients were treated using a graft-stent with/without coils, and underwent angiographic follow-up to evaluate the patency of the internal carotid artery (ICA). In all cases, symptoms related to CCF regressed after stent deployment and did not recur during follow-up. Follow-up angiography revealed good patency of the ICA in all patients. Graft-stents should be considered as an alternative means of treating CCF and preserving the parent artery by arterial wall reconstruction especially in patients with a fistula that cannot be successfully occluded with detachable balloons or coils.

• Journal of Chest Surgery
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• 제46권1호
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• pp.84-87
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• 2013

A 60-year-old man visited the outpatient clinic due to one month of recurrent exertional chest pain. Eleven years earlier he had undergone off-pump coronary artery bypass grafting using bilateral internal thoracic artery (ITA) Y-composite grafts based on the left ITA. Preoperative coronary angiography showed patent distal graft anastomoses and visualized the left ITA retrogradely. The arch aortography revealed near-total occlusion of the left subclavian artery at the level of the ostium. The patient underwent left carotid-to-subclavian artery bypass grafting using a 6 mm vascular conduit. Postoperative computed tomographic angiography revealed a patent bypass conduit between the left common carotid artery and left subclavian artery. The patient was discharged on postoperative day 4 with no symptoms or signs of myocardial ischemia.

• 대한한의학회지
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• 제28권2호통권70호
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• pp.44-53
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• 2007

Objectives : This study examined the neuroprotective effect of Hyulbuchookau-tang (血府逐瘀湯, HBCAT) against neural damage following global cerebral infarction. Methods : Sprague-Dawley rats were induced with global cerebral infarction by occlusion of the bilateral common carotid artery with hypotension (CCAO). The rats were divided into 3 groups. We treated extract of HBCAT to one group after operation (sample group), one group wasn't induced with ischemic damage after operation (sham group), and one group was induced with ischemic damage after operation (control group) but not treated. We observed neurological scores and cresyl violet-stained hippocampus CAl area, TUNEL-positive neurons, and Bax-positive neurons in brain regions. Results : HBCAT treatment after CCAO increased pyramidal neurons in CAl hippocampus induced by CCAO. HBCAT treatment after CCAO reduced Bax-positive neurons in CAl hippocampus of brain regions induced by CCAO. HBCAT treatment after CCAO wasn't effective for HSP70-positive neurons in CAl hippocampus induced by CCAO. Conclusions : These results suggest that HBCAT has a neuroprotective effect against global cerebral ischemia.

• The Korean Journal of Physiology and Pharmacology
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• 제12권3호
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• pp.89-94
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• 2008

In order to reproduce chronic cerebral hypoperfusion as it occurs in human aging and Alzheimer's disease, we introduced permanent, bilateral occlusion of the common carotid arteries (BCCAO) in rats (Farkas et al, 2007). Here, we induced BCCAO in two different rat strains in order to determine whether there was a strain difference in the pathogenic response to BCCAO. Male Wistar and Sprague-Dawley (SD) rats (250-270 g) were subjected to BCCAO for three weeks. Kluver-Barrera and cresyl violet staining were used to evaluate white matter and gray matter damage, respectively. Wistar rats had a considerably higher mortality rate (four of 14 rats) as compared to SD rats (one of 15 rats) following BCCAO. Complete loss of pupillary light reflex occurred in all Wistar rats that survived, but loss of pupillary light reflex did not occur at all in SD rats. Moreover, BCCAO induced marked vacuolation in the optic tract of Wistar rats as compared to SD rats. In contrast, SD rats showed fewer CA1 hippocampal neurons than Wistar rats following BCCAO. These results suggest that the neuropathological process induced by BCCAO takes place in a region-specific pattern that varies according to the strain of rat involved.

• 동의신경정신과학회지
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• 제20권2호
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• pp.111-120
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• 2009

Objectives : This study was performed to investigate the effects of Needle Electrode Electrical Stimulation (NEES) on ischemia-induced cerebrovascular accidents. After obstruction and reperfusion of ${\ast}{\ast}$ arteries in white mice, the amounts of necrosis and inflammation related substances IL-6, Caspase-3, and PARP, C-fos were measured in neurons of the hippocampus. The following results were obtained. Methods : This study used 21 male specific pathogen free (SPF) SD (Sprague Dawley) rats, 8 weeks of age and approximately 300 g in weight, that were given at least 1 week to adapt to the lab environment Each exposed artery was completely occluded with non-absorbent suture thread and kept in that state for 5 minutes. The sutures were then removed to allow reperfusion of blood. Test group is control group for comparison with the common carotid artery occlusion models, a GI group that underwent common carotid artery occlusion, and a needle electrode electrical stimulation (NEES) group that underwent NEES after artery occlusion. The GI and NEES groups were given 12, 24, or 48 hours of reperfusion before NEES. NEES device (PG6, ITO, Japan, 9V, current, 2Hz) was used to stimulate the right and left acupoint ST36 of the SD rats for 30 minutes while they were sedated with 3% isoflurane. An immunohistochemistry test was done on the forebrains of the GI induced rats. All the data collected from this study was symbolized and analyzed using a statistics processing program (SPSS 12.0K/PC). The level of significance was set at ${\alpha}$=0.05 and a T-TEST analysis was used to find out the effects of treatment on each of the groups: the normal group, the CVA induced group, and the treatment after CVA induction group. Results : Both PARP and C-fos immuno-reactive cells, related to apoptosis, were greater in the GI groups than the NEES group. Caspase and IL-6 immuno-reactive cells, related to inflammation, were greater in the GI and NEES groups than the control group. Conclusions : This research was conducted to study the effects of NEES on CVA due to ischemia. Occlusion and reperfusion was performed on the common carotid arteries of white rats, after which amounts of substances related to neuron necrosis and inflammation - PARP, IL-6, Caspase-3, and C-fos - were measured in the Hippocampus

• 대한임상검사과학회지
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• 제53권1호
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• pp.131-136
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• 2021

이중초음파는 반복적으로 검사를 실시할 수 있고, 비교적 저렴하기 때문에 다양한 진료분야에서 널리 이용되고 있다. 그중, 목동맥이중초음파는 뇌혈관질환을 진단하고 예후를 예측하는데 매우 유용한 비침습적 검사이다. 임상에서 목동맥이중초음파의 소요시간을 줄이고 결과의 정확성을 높이는 것은 매우 중요한 작업이다. 일반적으로 환자의 정보를 미리 숙지하는 것만으로도 신속히 정확한 검사를 수행할 수 있다. 하지만 예상과 달리 새롭게 발견되는 목 혈관질환으로 인해 검사하는데 종종 어려움을 겪기도 한다. 따라서 목 부위에서 발생할 수 있는 다양한 증례들을 숙지하는 것은 신속히 정확한 검사결과를 산출하는데 큰 도움이 될 것이다. 이러한 맥락에서, 본 연구는 목동맥이중초음파를 시행하던 중 예기치 않게 발견된 목 혈관질환 증례 3가지를 소개하고자 한다. 증례1. 속목동맥 폐색과 바깥목동맥으로부터 분지된 대뇌혈관; 증례 2. 속목정맥에서 관찰된 혈전; 증례 3. 척추동맥에서 관찰된 미세색전.

• Journal of Korean Neurosurgical Society
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• 제54권6호
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• pp.477-483
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• 2013

Objective : Although surgical techniques for clipping paraclinoid aneurysms have evolved significantly in recent times, direct microsurgical clipping of large and giant paraclinoid aneurysms remains a formidable surgical challenge. We review here our surgical experiences in direct surgical clipping of large and giant paraclinoid aneurysms, especially in dealing with anterior clinoidectomy, distal dural ring resection, optic canal unroofing, clipping techniques, and surgical complications. Methods : Between September 2001 and February 2012, we directly obliterated ten large and giant paraclinoid aneurysms. In all cases, tailored orbito-zygomatic craniotomies with extradural and/or intradural clinoidectomy were performed. The efficacy of surgical clipping was evaluated with postoperative digital subtraction angiography and computed tomographic angiography. Results : Of the ten cases reported, five each were of ruptured and unruptured aneurysms. Five aneurysms occurred in the carotid cave, two in the superior hypophyseal artery, two in the intracavernous, and one in the posterior wall. The mean diameter of the aneurysms sac was 18.8 mm in the greatest dimension. All large and giant paraclinoid aneurysms were obliterated with direct neck clipping without bypass. With the exception of the one intracavenous aneurysm, all large and giant paraclinoid aneurysms were occluded completely. Conclusion : The key features of successful surgical clipping of large and giant paraclinoid aneurysms include enhancing exposure of proximal neck of aneurysms, establishing proximal control, and completely obliterating aneurysms with minimal manipulation of the optic nerve. Our results suggest that internal carotid artery reconstruction using multiple fenestrated clips without bypass may potentially achieve complete occlusion of large paraclinoid aneurysms.

• Annals of Clinical Neurophysiology
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• 제18권1호
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• pp.1-6
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• 2016

Background: Moyamoya disease is characterized by a progressive stenosis or occlusion of the intracranial internal carotid artery and/or the proximal portion of the anterior cerebral artery and middle cerebral artery. Whether the onset time was childhood or adulthood, the bony carotid canal diameter might be different, but reflects the size of internal carotid artery passing through the bony carotid canal. In this study, we aimed to identify the relationship between bony carotid canal diameter and clinical manifestation. Methods: 146 consecutive patients diagnosed with moyamoya disease by brain imaging studies were included. We measured the diameter of a transverse portion of bony carotid canal on bone window of a brain computed tomography(CT) image. Patients were divided into two groups, ischemic or hemorrhagic stroke according to clinical manifestation. As a result, 115 patients were included. The Suzuki stage was used as criteria for disease progression. Results: Bony carotid canal diameter was $3.6{\pm}0.5$ (right) and $3.6{\pm}0.4$ (left) in the hemorrhagic stroke group, and $3.7{\pm}0.4$ (right) and $3.6{\pm}0.4$ (left) in the ischemic stroke group. The bony carotid canal diameter of the moyamoya vessels (3.6 mm) was smaller than the diameter of non-moyamoya vessels (3.8 mm), significantly (p = 0.042). However, there was no difference in the collateral patterns and clinical manifestation in a comparison of both groups. Conclusions: In our study, there was no significant difference of clinical manifestations and collateral patterns depend on the bony carotid canal diameter in patients with moyamoya disease. These findings suggest that the clinical presentations of moyamoya disease are not related to the onset time of the disease.

• 국제물리치료학회지
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• 제1권1호
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• pp.10-18
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• 2010

This study was performed to investigate the effects of Needle Electrode Electrical Stimulation(NEES) on ischemia-induced cerebrovascular accidents. After obstruction and reperfusion of arteries in white mice, the amounts of necrosis and inflammation related substances Bax, IL-6, Caspase-3, and COX-2 were measured in neurons of the fore-brain. The following results were obtained. This study used 21 male specific pathogen free(SPF) SD rats, 8 weeks of age and approximately 300g in weight. Each exposed artery was completely occluded with non-absorbent suture thread and kept in that state for 5 minutes. The sutures were then removed to allow reperfusion of blood. Test group is control group(common carotid artery occlusion models), a GI(underwent common carotid artery occlusion), and NEES(underwent NEES after artery occlusion). The GI and NEES groups were given 12, 24, or 48 hours of reperfusion before NEES. NEES device(PG6, ITO, Japan, 9V, current, 2Hz) was used to stimulate the bilateral acupoint ST36 of the SD rats for 30 minutes while they were sedated with 3% isoflurane. An immuno-histochemistry test was done on the forebrains of the GI induced rats. Both Bax and Caspase-3 immuno-reactive cells, related to apoptosis, were greater in the GI than the NEES group. Cox-2 and IL-6 immuno-reactive cells, related to inflammation, were greater in the GI and NEES groups than the control group. We can expect that applying NEES after ischemic CVA is effective for preventing brain cells from being destroyed. And we can conclude NEES should be applyed on early stage of ischemic CVA.

• Journal of Korean Neurosurgical Society
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• 제63권1호
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• pp.34-44
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• 2020

Objective : Despite widespread use of flow diverters (FDs) to treat aneurysms, the exact healing mechanism associated with FDs remains poorly understood. We aim to describe the healing process of aneurysms treated using FDs by demonstrating the histopathologic progression in a canine aneurysm model. Methods : Twenty-one side wall aneurysms were created in common carotid artery of eight dogs and treated with two different FDs. Angiographic follow-ups were done immediately after placement of the device, 4 weeks and 12 weeks. At last follow-up, the aneurysm and the device-implanted parent artery were harvested. Results : Histopathologic findings of aneurysms at 4 weeks follow-up showed intra-aneurysm thrombus formation in laminating fashion, and neointimal thickening at the mid-segment of aneurysm. However, there are inhomogenous findings in aneurysms treated with the same type of FD showing same angiographic outcomes. At 12 weeks, aneurysms of complete and near-complete occlusion revealed markedly shrunken aneurysm filled with organized connective tissues with thin neointima. Aneurysms of incomplete occlusion at 12 weeks showed small amount of organized thrombus around fringe neck and large empty space with thick neointmal formation. Neointimal thickness and diameter stenosis was not significantly different between the groups of FD specification and follow-up period. Conclusion : Intra-aneurysmal thrombus formation and organization seem to be an important factor for the complete occlusion of aneurysms treated using the FD. Neointimal formation could occur along the struts of the FD independently of intra-aneurysmal thrombus formation. However, neointimal formation could not solely lead to complete aneurysm healing.