• Journal of Yeungnam Medical Science
• /
• v.26 no.1
• /
• pp.78-83
• /
• 2009

Fibromuscular dysplasiais an uncommon condition of idiopathic, non-inflammatory and non-atherosclerotic disease of the musculature of arterial walls. The disease is rare, but it commonly affects young and middle aged women. Isolated intracranial cerebral fibromuscular dysplasia is extremely rare because cerebral fibromuscular dysplasia usually affects extracranial vessels. A 20-year-old woman was admitted with light hemiplegia and global aphasia. Brain MRI and MRA demonstrated acute left middle cerebral artery territory infarction with a multifocal stenosis and dilatation of the left middle cerebra artery and left internal carotid. The characteristic conventional cerebral angiographic findings demonstrated a typical string-of-beads appearance in the left distal internal carotid artery and proxiaml portion of the left middle cerebral artery, which suggested a medial type fibromuscular dysplasia. We report a case of isolated intracranial fibromuscular dysplasia with left middle cerebral artery territory infarction. Fibromuscular dysplasia should he considered as a stroke risk factors in children and young adults, especially in patients with no known cardiovascular risk factors.

• Journal of Korean Neurosurgical Society
• /
• v.65 no.4
• /
• pp.603-608
• /
• 2022

Vertebral artery (VA) occlusion is frequently encountered, usually without acute ischemic injury of the brain. However, when it is accompanied by hypoplasia or stenosis of the opposite VA, brain ischemia may develop due to insufficient collateral supply. Both hemodynamic instability and embolic infarction can occur in VA occlusion, which may cause severe symptoms in a patient. Extracranial carotid-VA bypass should be considered for symptomatic VA occlusion patients, especially when the patient has repeated ischemic brain injuries. In this report, the cases of three extracranial carotid-VA bypass patients are introduced, along with a brief description of the surgical techniques. All three cases were treated with different bypass methods according to their disease location.

• Journal of Korean Neurosurgical Society
• /
• v.51 no.6
• /
• pp.370-373
• /
• 2012

The intracranial stent functions primarily to prevent protrusion of coils into the parent vessel during the embolization of wide-necked cerebral aneurysms and might also reduce aneurysm recanalization rate. In spite of these advantages, little is known about the long-term interaction of the stent with the parent vessel wall. We present a rare case of severe in-stent stenosis occurring as a delayed complication of Neuroform stent-assisted coil embolization of an unruptured intracranial aneurysm.

• Journal of Korean Neurosurgical Society
• /
• v.65 no.3
• /
• pp.422-429
• /
• 2022

Objective : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs. Methods : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed. Results : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5-77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91). Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.

• Journal of the Korean Society of Visualization
• /
• v.20 no.1
• /
• pp.52-63
• /
• 2022

Direct numerical simulation of blood flow in a stenosed, patient-specific carotid artery was conducted to explore the transient behavior of blood flow with special emphasis on the wall-shear stress distribution over the transition region. We assumed the blood as an incompressible Newtonian fluid, and the vessel was treated as a solid wall. The pulsatile boundary condition was applied at the inlet of the carotid. The Reynolds number is 884 based on the inlet diameter, and the maximum flow rate and the corresponding Womersley number is approximately 5.9. We found the transitional behavior during the acceleration and deceleration phases. In order to quantitatively examine the wall-shear stress distribution over the transition region, the probability density function of the wall-shear stress was computed. It showed that the negative wall-shear stress events frequently occur near peak systole. In addition, the oscillatory shear stress index was used to further analyze the relationship with the negative wall-shear stress appearing in the systolic phase.

• Korean Journal of Clinical Laboratory Science
• /
• v.49 no.3
• /
• pp.316-321
• /
• 2017

The occurrence of subclavian steal syndrome is possible in patients with either severe stenosis or occlusion in the left proximal subclavian or brachiocephalic arteries. Limited and insufficient blood flow in the vessel with a lesion induces blood supply from the opposite side via any of the connected vessels, which is called a subclavian steal phenomenon. The duplex sonography is useful for detecting this phenomenon. Some patients who experience this phenomenon complain of vertebrobasilar insufficiency, such as headache or numbness and weakness in the arm, and so on. Subclavian steal syndrome means subclavian steal phenomenon accompanied by these symptoms. We present a patient with focal severe stenosis of the brachiocephalic artery, manifested as blood flow reversal in the vertebral, and a "to-and-fro" waveform pattern in the external carotid, internal carotid, and common carotid arteries.

• Clinical and Experimental Pediatrics
• /
• v.52 no.9
• /
• pp.1044-1047
• /
• 2009

A 13-year-old girl with psoriasis of the elbow, trunk, and face suddenly developed a severe headache followed by left hemiparesis and facial palsy. Brain magnetic resonance imaging showed an acute infarction of the right temporofrontal lobe and basal ganglia on the T2- and diffusion-weighted images. Cerebral angiography showed pre-occlusive irregular scalloped stenosis (99%) in the proximal M1 segment of the right middle cerebral artery and a web-like stenosis at the supraclinoid portion of the right internal carotid artery (ICA) suggestive of a spontaneous intracranial ICA dissection. The patient was administered a low dose of dipyridamole, and a rehabilitation program was initiated. Headache, left motor weakness, and facial droop improved within a week. However, mild left facial palsy and reduced fine motor function of the left hand were still present after 3 weeks. We report a rare case of spontaneous intracranial ICA dissection in a child with psoriasis.

• Journal of Korean Neurosurgical Society
• /
• v.60 no.5
• /
• pp.511-517
• /
• 2017

Objective : Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. Methods : A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. Results : Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS ($67.6{\pm}11.8$ vs. $58.9{\pm}13.6years$ p=0.004) and cerebral arterial stenosis ($67.9{\pm}11.6$ vs. $59.3{\pm}13.5years$, p<0.001) compared to those without stenosis. Patients with ICAS were older, more frequently had diabetes, had a higher serum glucose level, and had a lower hemoglobin level than those without ICAS. Patients with cerebral arterial stenosis were older, had diabetes and lower hemoglobin level, which was consistent with findings in patients with ICAS. However, patients with cerebral arterial stenosis showed higher prevalence of hypertension and decreased kidney function compared to those without cerebral arterial stenosis. Multivariable logistic regression analyses showed that aging and presence of diabetes independently predicted the presence of ICAS, and aging, diabetes, and hypertension were independently associated with presence of cerebral arterial stenosis. Conclusion : 19.2% of patients with spontaneous ICH had ICAS, but the prevalence of ECAS was relatively lower (7.2%) compared with ICAS. Aging and diabetes were independent factors for the presence of ICAS, whereas aging, hypertension, and diabetes were factors for the cerebral arterial stenosis.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.18 no.8
• /
• pp.84-87
• /
• 2017

Cerebral hyperperfusion syndrome (CHS) is a rare complication that can occur when conducting stent insertion or endarterectomy in patients with carotid artery stenosis and is known to be caused by various mechanisms when the blood volume abruptly increases. The main clinical symptoms are unilateral headache, hypertension, seizure, and focal neurologic deficit. Subarachnoid hemorrhage and parenchymal hemorrhage may lead to permanent impairment or death in severe cases. CHS can be predicted by using transcranial Doppler, perfusion magnetic resonance imaging, and single photon emission computed tomography. In our case report, a patient developed CHS subsequent to significant venous congestion caused by carotid artery stent insertion. The patient had preexisting, symptomatic bilateral carotid artery stenosis. Venous congestion occurs when the direction of blood flow changes because of increased blood volume in patients with well-developed collateral vessels. We believe that CHS can be predicted from this finding. This study reports the possibility that CHS could be confirmed by cerebral angiography after insertion of the internal carotid stent.

• Journal of Preventive Medicine and Public Health
• /
• v.42 no.5
• /
• pp.298-304
• /
• 2009

Objectives : The aim of this study was to investigate the association of blood pressure levels with the common carotid artery intima-media thickness (CCA-IMT) and carotid plaques. Methods : Data were obtained from 2,635 subjects, aged 50 years and over, who participated in the Community Health Survey (a population-based, cross-sectional study) in Dong-gu, Gwangju city between 2007 and 2008. Participants were categorized into three groups according to blood pressure levels; normotensives (<120/80 mmHg), prehypertensives (120-139/80-89 mmHg), and hypertensives ($\geq$140/90 mmHg). Prehypertensives were further categorized as low prehypertensives (120-129/80-84 mmHg) and high prehypertensives (130-139/85-89 mmHg). Carotid intima-media thickness and plaques were evaluated with a high-resolution B-mode ultrasound. Statistical analyses were performed using chi-square test, ANOVA, and multiple logistic regression. Results : Prehypertensives had significantly greater maximal CCA-IMT values than normotensives, with a multivariate adjusted odds ratio of 1.78 (95% CI=1.36-2.32) for abnormal CCA-IMT (maximal CCA-IMT$\geq$1.0 mm), and 1.45 (95% CI=1.19-1.77) for carotid plaques. The multivariate adjusted odds ratio of low prehypertensives was 1.64 (95% CI=1.21-2.21) for abnormal CCA-IMT, and 1.30 (95% CI=1.04-1.63) for carotid plaques compared with normotensives. Subject with hypertension had higher frequency of abnormal CCA-IMT (odds ratio, 2.18; 95% CI=1.49-3.18), and carotid plaques (odds ratio, 1.98; 95% CI=1.46-2.67) compared with normotensives after adjustment for other cardiovascular risk factors. Conclusions : Our results indicate that there is a significant increase in the prevalence of carotid atherosclerosis in subjects with prehypertension (even in low prehypertensives) compared with normotensive subjects. Further studies are required to confirm the benefits and role of carotid ultrasonography in persons with prehypertension.