• 제목/요약/키워드: Carotid stenosis

검색결과 122건 처리시간 0.031초

Volumetric modulated arc therapy for carotid sparing in the management of early glottic cancer

  • Kim, Young Suk;Lee, Jaegi;Park, Jong In;Sung, Wonmo;Lee, Sol Min;Kim, Gwi Eon
    • Radiation Oncology Journal
    • /
    • 제34권1호
    • /
    • pp.18-25
    • /
    • 2016
  • Purpose: Radiotherapy of the neck is known to cause carotid artery stenosis. We compared the carotid artery dose received between volumetric modulated arc therapy (VMAT) and conventional fixed-field intensity-modulated radiotherapy (IMRT) plans in patients with early glottic cancer. Materials and Methods: Twenty-one early glottic cancer patients who previously underwent definitive radiotherapy were selected for this study. For each patient, double arc VMAT, 8-field IMRT, 3-dimensional conformal radiotherapy (3DCRT), and lateral parallel-opposed photon field radiotherapy (LPRT) plans were created. The 3DCRT plan was generated using lateral parallel-opposed photon fields plus an anterior photon field. VMAT and IMRT treatment plan optimization was performed under standardized conditions to obtain adequate target volume coverage and spare the carotid artery. Dose-volume specifications for the VMAT, IMRT, 3DCRT, and LPRT plans were calculated with radiotherapy planning system. Monitor units (MUs) and delivery time were measured to evaluate treatment efficiency. Results: Target volume coverage and homogeneity results were comparable between VMAT and IMRT; however, VMAT was superior to IMRT for carotid artery dose sparing. The mean dose to the carotid arteries in double arc VMAT was reduced by 6.8% compared to fixed-field IMRT (p < 0.001). The MUs for VMAT and IMRT were not significantly different (p = 0.089). VMAT allowed an approximately two-fold reduction in treatment delivery time in comparison to IMRT (3 to 5 minutes vs. 5 to 10 minutes). Conclusion: VMAT resulted in a lower carotid artery dose compared to conventional fixed-field IMRT, and maintained good target coverage in patients with early glottic cancer.

Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature

  • Cho, Young Dae;Kim, Sung-Eun;Lim, Jeong Wook;Choi, Hyuk Jai;Cho, Yong Jun;Jeon, Jin Pyeong
    • Journal of Korean Neurosurgical Society
    • /
    • 제61권4호
    • /
    • pp.458-466
    • /
    • 2018
  • Objective : To compare peri-operative any symptomatic stroke after carotid angioplasty and stenting (CAS), based on the application or absence of a cerebral protection device. Methods : A systematic literature review using PubMed, Embase, and the Cochrane Central was done across an online data base from January 1995 to October 2016. Procedures which were performed due to carotid dissection or aneurysm, procedures using covered stents or conducted in an emergency, were excluded. The primary endpoint was perioperative any symptomatic stroke within 30 days after the procedure. A fixed effect model was used in cases of heterogeneity less than 50%. Results : In the 25 articles included in this study, the number of stroke events was 326 (2.0%) in protected CAS and 142 (3.4%) in unprotected CAS. The use of cerebral protection device significantly decreased stroke after CAS (odds ratio [OR] 0.633, 95% confidence interval [CI] 0.479-0.837, p=0.001). In the publication bias analysis, Egger's regression test disclosed that the intercept was -0.317 (95% CI -1.015-0.382, p=0.358). Regarding symptomatic patients (four studies, 539 CAS procedures), the number of stroke was six (1.7%) in protected CAS and 11 (5.7%) in unprotected CAS. The protective effect against stroke events by cerebral protection device did not have a statistical significance (OR 0.455, 95% CI 0.151-1.366, p=0.160). Conclusion : The use of protection device significantly decreased stroke after CAS. However, its efficacy was not demonstrated in symptomatic patients. Routine use of protection device during CAS should be critically assessed before mandatory use.

적혈구 증가증으로 인한 급성 뇌경색에서 경동맥 혈관벽 자기공명영상 소견: 증례 보고 (Carotid Vessel Wall MRI Findings in Acute Cerebral Infarction Caused by Polycythemia Vera: A Case Report)

  • 박준경;이은자;김동억;이현정
    • 대한영상의학회지
    • /
    • 제83권1호
    • /
    • pp.178-183
    • /
    • 2022
  • 진성적혈구증가증은 드문 골수 증식성 질환이며 제어되지 않은 적혈구 생산으로 인해 절대 적혈구 질량이 증가한다. 진성적혈구증가증은 큰 혈관의 협착 또는 폐색과 함께 허혈성 뇌졸중의 위험이 높다. 진성적혈구증가증 환자에서 뇌경색에 대한 많은 증례 보고가 있다. 그러나 합병증으로 뇌졸중이 발생한 진성적혈구증가증 환자의 좁아진 혈관에서 혈관벽 자기공명영상 소견은 보고되지 않았다. 저자들은 뇌졸중으로 인해 입원한 후 PV로 진단된 30세 남성의 경동맥 VW-MRI 소견에 관해 보고하고자 하며, 이는 우리가 아는 한 영어로 된 첫 번째 보고이다.

조기 성문암의 방사선치료에서 경동맥을 보호하기 위한 치료 계획 (Treatment Planning for Minimizing Carotid Artery Dose in the Radiotherapy of Early Glottic Cancer)

  • 기용간;김원택;남지호;김동현;이주혜;박달;김동원
    • Radiation Oncology Journal
    • /
    • 제29권2호
    • /
    • pp.115-120
    • /
    • 2011
  • 목 적: 조기 성문암 환자에서 방사선치료의 만기 합병증인 뇌졸증을 예방하기 위해 경동맥을 보호하는 치료계획을 세우고 타당성을 알아보고자 연구를 계획하였다. 대상 및 방법: 2007년 1월부터 2010년 12월까지 원발성 조기 성문암으로 방사선치료를 받은 환자 중 전산화단층촬영모의 치료를 받은 환자 31명의 모의치료 영상을 대상으로 하였다. 기존의 평행대항조사영역(parallel-opposing field, POF)과 조사영역의 빔방향상에서 동측의 경동맥을 제외하기 위해 빔각도를 조절한 조사영역(modified oblique field, MOF)으로 가상모의치료계획을 세우고 계획용표적체적, 경동맥과 척수의 선량분포, 평균선량과 $V_{35}$, $V_{40}$, $V_{50}$ 등을 기존 치료와 비교 분석하였다. 결 과: 전체 31명 중 23명(74.2%)에서 25도, 8명(25.8%)에서 30도 전방으로 조절되었다. 두 군 사이에 선량에 따른 Planning target volume의 체적백분율은 차이를 보이지 않았다(p=0.801). 경동맥의 선량에 따른 누적 체적백분율은 의미 있는 차이를 보였고(p<0.001), 26 Gy 이후에 MOF군에서 감소하기 시작했다. 경동맥의 평균선량은 POF군에서 38.5 Gy, MOF군에서 26.3 Gy였고(p=0.012), $V_{35}$, $V_{40}$, $V_{50}$ 모두에서 의미 있는 차이를 보였다. 결 론: 이번 연구 결과로 조기 성문암 환자에서 빔각도를 전방으로 조절하여 경동맥의 조사선량을 감소시켰다. 이를 통해 경동맥 협착증을 예방하고 궁극적으로 뇌졸증을 줄일 수 있을 것으로 예상한다.

대동맥 축착증 및 심한 대동맥 협착을 가진 저체중 신생아(2.4 kg)의 수술 전후 발생한 심실 기능 부전의 치료에 대한 양심실 보조 장치 적용 치험 예 (The Application of a Bi-ventricular Assist Device for a Low Weight (2.4 kg) Neonate with Coarctation of the Aorta and Critical Aortic Stenosis)

  • 곽재건;박천수;이창하;이철
    • Journal of Chest Surgery
    • /
    • 제43권3호
    • /
    • pp.304-307
    • /
    • 2010
  • 대동맥 축착증 및 심한 대동맥 협착을 가진 생후 5일의 환자가 대동맥 협착을 해결하려는 중재적 시술 도중 유도 카테터에 의한 우측 경동맥 손상으로 인한 출혈 및 심낭 내 탐폰으로 인한 심정지가 발생하여 심폐소생술 후 체외막성산화기 보조를 받았다. 환자의 체중은 2.4 kg이었다. 1일 후 수술적 완전 교정술을 시행하였으나, 수술 직후 심한 심기능 저하로 인하여 양심실 보조 장치로 순환 보조를 하였고, 3일 후 양심실 보조 장치 이탈에 성공하였다. 이후 환자는 일반적인 치료 후 특별한 문제없이 퇴원하였다.

Cerebellar Hemorrhage due to a Direct Carotid-Cavernous Fistula after Surgery for Maxillary Cancer

  • Kamio, Yoshinobu;Hiramatsu, Hisaya;Kamiya, Mika;Yamashita, Shuhei;Namba, Hiroki
    • Journal of Korean Neurosurgical Society
    • /
    • 제60권1호
    • /
    • pp.89-93
    • /
    • 2017
  • Infratentorial cerebral hemorrhage due to a direct carotid-cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus.

울금(鬱金)에서 분리된 demethoxycurcumin이 백서의 혈관재협착에 미치는 효과 (Effects of Demethoxycurcumin Isolated from Radix Curcumae on Arterial Restenosis in Rats)

  • 길인호;정명수;신창호;배현옥;정헌택;이기남
    • 대한예방한의학회지
    • /
    • 제12권3호
    • /
    • pp.67-80
    • /
    • 2008
  • The pathobiologic process of arterial stenosis following balloon angioplasty continues to be an enigmatic problem in clinical settings. This study investigates the ability of demethoxycurcumin, a curcuminoid isolated from Radix Curcumae, to attenuate balloon injury-induced neointima(NI) formation in the rat carotid artery. It was found that demethoxycurcumin induced inducible heme oxygenase(HO-1) expression and inhibited dose-dependently cellular proliferation in rat vascular smooth muscle cells. Perivascular application of demethoxycurcumin immediately following injury significantly reduced NI area and NI thickness 2 weeks post-injury. Interestingly, treatment with tin-protoporphyrin IX, a HO inhibitor, reversed the effects of demethoxycurcumin on NI formation. These results implicate demethoxycurcumin as a potent new therapeutic agent that is capable of reducing post-angioplasty arterial stenosis through induction of the HO-1 expression.

  • PDF

뇌경색 환자의 경동맥 내막 두께와 사속도맥파 검사의 관련성 연구 (Study on the Relationship between Carotid Intima-Media Thickness and The Second Derivative of Photoplethysmogram Waveforms in Ischemic Stroke Patients)

  • 강경화;김경민
    • 동의생리병리학회지
    • /
    • 제29권2호
    • /
    • pp.160-167
    • /
    • 2015
  • The purpose of this study was to investigate the correlation of Intima-Media Thickness of common carotid artery(CCA-IMT) and The Second Derivative of Photoplethysmogram Waveforms(SDPTG). 38 subjects with acute ischemic stroke were recruited from the patients admitted to Dong-Eui Medical Center from the June 2013 to January 2014. We assessed 38 patient's SDPTG data and CCA-IMT data by B Mode ultrasonography. then 38 subjects were divided into two groups by the CCA-IMT difference; CCA-IMT 〈 0.8 mm group(n=11), CCA-IMT $$\geq_-$$ 0.8 mm group(n=27). We analyzed their characteristics, risk factor, blood test result, life style by CCA-IMT difference. As a result, Age, Hypertension were significantly higher in the CCA-IMT $$\geq_-$$ 0.8 mm group then in the CCA-IMT < 0.8 mm group. Regular exercise were significantly higher in the CCA-IMT < 0.8 mm group then in the CCA-IMT $$\geq_-$$ 0.8 mm group. The result of Multiple regression analysis on the factors affecting the CCA-IMT was hypertension, total cholesterol, age. and The result of Pearson's Correlation analysis on CCA-IMT and SDPTG is that e/a ratio, SDPTG AI were respectively and significantly correlated with CCA-IMT. According to the analysis, the Relationship between CCA-IMT and SDPTG in Ischemic Stroke Patients were founded. We suggest that further investigation with larger and better controlled trials of the Relationship between CCA-IMT and SDPTG could contribute to better understand the effects of risk factors on atherosclerosis.

Impact of Controlling Nutritional Status score on short-term outcomes after carotid endarterectomy: a retrospective cohort study

  • Hee Won Son;Gyeongseok Yu;Seung Jun Lee;Jimi Oh
    • Journal of Yeungnam Medical Science
    • /
    • 제40권3호
    • /
    • pp.259-267
    • /
    • 2023
  • Background: Malnutrition and impaired immune responses significantly affect the clinical outcomes of patients with atherosclerotic stenosis. The Controlling Nutritional Status (CONUT) score has recently been utilized to evaluate perioperative immunonutritional status. This study aimed to evaluate the relationship between immunonutritional status, indexed by CONUT score, and postoperative complications in patients undergoing carotid endarterectomy (CEA). Methods: We retrospectively evaluated 188 patients who underwent elective CEA between January 2010 and December 2019. The preoperative CONUT score was calculated as the sum of the serum albumin concentration, total cholesterol level, and total lymphocyte count. The primary outcome was postoperative complications within 30 days after CEA, including major adverse cardiovascular events, pulmonary complications, stroke, renal failure, sepsis, wounds, and gastrointestinal complications. Cox proportional hazards regression analysis was used to estimate the factors associated with postoperative complications during the 30-day follow-up period. Results: Twenty-five patients (13.3%) had at least one major complication. The incidence of postoperative complications was identified more frequently in the high CONUT group (12 of 27, 44.4% vs. 13 of 161, 8.1%; p<0.001). Multivariate analyses showed that a high preoperative CONUT score was independently associated with 30-day postoperative complications (hazard ratio, 5.98; 95% confidence interval, 2.56-13.97; p<0.001). Conclusion: Our results showed that the CONUT score, a simple and readily available parameter using only objective laboratory values, is independently associated with early postoperative complications.

도플러 초음파를 이용한 중풍환자(中風患者)의 뇌혈관(腦血管) 혈류측정(血流測定)에 관한 임상적(臨床的) 연구(硏究) (경동맥(頸動脈), 추골동맥(椎骨動脈) 및 기저동맥(基底動脈)을 중심으로) (Clinical study on the estimation of blood flow velocity using doppler ultrasound of the cerebral artery in stroke patients)

  • 장인수;선중기
    • 대한한의학회지
    • /
    • 제17권1호
    • /
    • pp.345-360
    • /
    • 1996
  • Background and Purpose: To evaluate the blood flow velocity using doppler ultrasound of the carotid artery, vertebral artery, and basilar artery in stroke patients Material and Methods: To evaluate the blood flow, I measured the peak systolic velocity and mean velocity of the common carotid artery(CCA), internal carotid artery(ICA), external carotid artery (ECA). vertebral artery(VA), and basilar artery(BA) in 44 stroke patients and 15 healthy adults. To investigate the difference between ischemic stroke patients and normal healthy adults, I selected 44 ischemic stroke patients diagnosed by brain CT and brain MRI, and 15 healthy adults who did not have any symptoms of stroke, hypertension, heart disease, and diabetes melitus. Results: Peak velocity in normal adults was 50.6${\pm}$1.6cm/sec in the CCA, 67.2${\pm}$1.7cm/sec in the ICA, 62.5${\pm}$2.4cm/see in the ECA, 45.5${\pm}$1.9cm/sec VA. and 50.5${\pm}$3.5cm/sec in the BA. Mean velocity in normal adults was 26.9${\pm}$1.1cm/sec in the CCA, 43.7${\pm}$1.4cm/sec in the ICA, 26.7${\pm}$1.3cm/sec in the ECA. 31.6${\pm}$1.9cm/sec in the VA and 33.0${\pm}$2.6cm/sec in the BA. In this study, there was a significant increase in the velocity of ICA, ECA, and VA of ischemic stroke patients in comparison with normal healthy adults. And the blood flow velocity of this study in the CCA and ECA was different from other reported foreign values and the other known values in my country. Conclusion: There was a significant difference in the blood flow velocity between ischemic stroke patients and normal healthy adults. And the blood flow velocity of this study was different from other reported foreign values and the other known values in my country. Therefore, it needs more detailed studies about old aged Korean and ischemic stroke patients than previous studies.

  • PDF