• Journal of Korean Neurosurgical Society
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• 제65권6호
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• pp.801-815
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• 2022

Objective : To evaluate the stent apposition of a low-profile visualized intraluminal support (LVIS) device in distal internal carotid artery (ICA) aneurysms, examine its correlation with clinical and angiographic outcomes, and determine the predictive factors of ischemic adverse events (IAEs) related to stent-assisted coiling. Methods : We retrospectively analyzed a prospectively maintained database of 183 patients between January 2017 and February 2020. The carotid siphon from the cavernous ICA to the ICA terminus was divided into posterior, anterior, and superior bends. The anterior bends were categorized into angled (V) and non-angled (C, U, and S) types depending on the morphology and measured angles. Complete stent apposition (CSA) and incomplete stent apposition (ISA) were evaluated using unsubtracted angiography and flat-panel detector computed tomography. Dual antiplatelet therapy with aspirin 200 mg and clopidogrel 75 mg was administered. Clopidogrel resistance was defined as fewer responders (≥10%, <40%) and non-responders (<10%) based on the percent inhibition (%INH) of the VerifyNow system. These were counteracted by a dose escalation to 150 mg for fewer responders or substitution with cilostazol 200 mg for non-responders. IAEs included intraoperative in-stent thrombosis, transient ischemic attack, cerebral infarction, and delayed in-stent stenosis. A multivariate logistic regression analysis was used to determine the predictive factors for ISA and IAEs. Results : There were 33 ISAs (18.0%) and 27 IAEs (14.8%). The anterior bend angle was narrower in ISA (-4.16°±25.18°) than in CSA (23.52°±23.13°) (p<0.001). The V- and S-types were independently correlated with the ISA (p<0.001). However, treatment outcomes, including IAEs (15.3% vs. 12.1%), aneurysmal complete occlusion (91.3% vs. 88.6%), and recanalization (none of them), did not differ between CSA and ISA (p>0.05). The %INH of 27 IAEs (13.78%±14.78%) was significantly lower than that of 156 non-IAEs (26.82%±20.23%) (p<0.001). Non-responders to clopidogrel were the only significant predictive factor for IAEs (p=0.001). Conclusion : The angled and tortuous anatomical peculiarity of the carotid siphon caused ISA of the LVIS device; however, it did not affect clinical and angiographic outcomes, while the non-responders to clopidogrel affected the IAEs related to stent-assisted coiling.

• 대한핵의학회지
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• 제36권6호
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• pp.357-367
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• 2002

목적: 뇌혈관질환에 있어서 뇌혈류와 뇌혈류예비능을 기저/아세타졸아미드 뇌혈류SPECT로 평가 가능하나 재관류 수술효과를 비교 평가하기 위해서는 정량적인 평가가 필요하다. 대상 및 방법: 12명의 환자($51{\pm}15$세, 남:녀:6:6)의 수술 전후 기저 시와 아세타졸아미드 부하 뇌관류 SPECT를 SPM에서 공간정규화하고 소뇌의 계수를 기준으로 계수정규화한 후 확률뇌지도(statistical probabilistic anatomical map, SPAM)를 이용하여 부위별 혈류를 정량화하였다. 이 결과로부터 수술 전후 및 정상대조군($59{\pm}15$세, 남:녀:10:11)과의 비교를 McNemar test와 Mannwhitney test를 이용하여 비교하였다. 혈류예비능은 기저 시와 부하시의 차이를 기저 시 계수를 기준으로 백분율로 표현하였다. 결과: 수술 후 수술 부위의 기저 시와 아세타졸아미드 부하 시 혈류 그리고 혈류예비능 모두가 유의하게 향상되었다(p<0.05). 정상군과의 비교에 있어서는 기저 시 혈류는 정상군과 차이가 없을 정도로 호전되었으나, 아세타졸아미드 부하시 혈류와 혈류예비능은 수술 후에도 유의한 차이를 보였다(p<0.05). 혈류예비능은 주로 수술부위를 중심으로 향상되었다. 결론: SPM 및 SPAM을 이용하여 기저/아세타졸아미드 뇌혈류 SPECT의 수술 전후결과를 정량적, 객관적으로 쉽게 비교 평가할 수 있다.

• 대한디지털의료영상학회논문지
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• 제13권2호
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• pp.83-90
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• 2011

To prospectively determine the diagnostic performance a combination of standard bolus-chase magnetic resonance (MR) angiography and MR angiography with time-resolved imaging of contrast kinetics (TRICKS) for depicting severity of the head and neck vascular diseases. Over a period of two months, A total of 100 patients(average ages : $50{\pm}8$, male : 60, female : 40) with head and neck vascular diseases were performed on the GE excite 3.0 T units with 8-channel head coil and 4-channel NV coil. Imaging parameters for a typical study were as follow: SBC(TR/ TE/ FA/ SliceThicken./ Slab/ Freq./ FOV/ BW/Scan Time) = 5.4/ min/ 30/ 2/ zip2/ 70/ $224{\times}448$/ 30/ 62.50/ 28, TRICKS(TR/ TE/ FA/ Slice Thicken/Slab/ Freq./ FOV/ BW/ Temp Res./ Scan Time = 3.6/ min/ 25/ 4/ 30/ $160{\pm}384$, zip512/ 30/ 100/ 1 to 1.5/ 23). The analysis of all MR images, which have respect-ively classified two techniques into some diseases. The results of the former were divided into two groups(SBC, TRICKS)with 4 grading of two reader, respectively. Wilcoxon signed rank test was used to determine if a significant difference between imaging techniques existed(p < 0.05). In 33 of 100 patients, arterio-venous malformation was 11% at TRICKS, subclavian vein stenosis : 8%, fistular sinus : 4%, jugular vein stenosis:6%, Middle Cerebral Artery bypass surgery : 4%, p < 0.05). The rest of 67 patients were considered as the results of SBC(14% in the basilar artery stenosis, carotid stenosis : 16%, vertebral stenosis : 17%, central neuro-cytoma : 5%, meningioma : 5%, Not appliable : 10%, p < 0.05). Sensitivity and specificity of TRICKS MR angiography in SVS, FS, JVS, MCABS were improved compared with those at standard MR angiography. In SBS MR angiography which were improved in BAS, CS, VS, CN, Meningioma. In conclusion, TRICKS MR angiography of the SVS, FS, JVS, MCABS is superior to standard MR angiography regarding the number of diagnostic grading. The SBS MR angiography were improved in BAS, CS, VS, CN, Meningioma. and assessment of the degree of luminal narrowing on both TRICKS and SBS.

• 대한물리치료과학회지
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• 제6권4호
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• pp.153-165
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• 1999

The transcranial Doppler(TCD) is a technique for measuring blood flow velocity of intracranial and extarcranial arteries. This examination based on Doppler effect which was first formulated in 1842 by the Austrian physicist Christian Doppler. In 1982, Rune Aaslid first maked 2MHz pulsed probe and recording intracranial vessels with transcranially. There are six criteria utilized in gaining positive identification of the intracranial vessels. The six criteria are as follows l)acoustical windows 2)depth of sample volume 3)direction of flow 4)spatial relationship of ACA and MCA bifurcation 5)mean velocity and 6)response common carotid artery compression and/or oscillation test. The affected factors for TCD examination are angle of insonation, posture of subject, age, gender, hematocrit, metabolic factors, and cardiac output. Clinical application of TCD are detection of stenosis, occlusion, emboli, thrombsis in intracranial and extracranial arteries and evaluation of cerebral arterovenous malformation, collateral capacity in the circle of Willis, ischemia cerebrovascular disease, stroke patient and vertebrobasilar system.

• Journal of Korean Neurosurgical Society
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• 제59권3호
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• pp.296-301
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• 2016

Dural arteriovenous fistula (DAVF) of the transverse sinus with ophthalmic manifestations in young children are rare. We reviewed two cases of direct AVF of the transverse sinus with ocular manifestations managed at our institution. The first, a 2.5 years old male child presented with left exophthalmos. Angiography revealed AVF between the occipital artery and the transverse sinus. The second, a 2 years old female child, complained of left exophthalmos. Imaging studies showed bilateral direct AVFs of the transverse sinus with bilateral dysmaturation of the sigmoid sinus. Transarterial embolization was done in both cases. Clinical and radiological follow up revealed complete cure. This report suggests that DAVF of the transverse sinus supplied by the external carotid branches can present with ophthalmic manifestations especially if there is distal venous stenosis or obliteration involving sigmoid sinus. Transarterial embolization using coils and liquid embolic agents could be safe and feasible to obliterate the fistula.

• Journal of Korean Neurosurgical Society
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• 제57권6호
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• pp.432-435
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• 2015

Moyamoya disease is a unique cerebrovascular disorder characterized by idiopathic progressive stenosis at the terminal portion of the internal carotid artery (ICA) and fine vascular network. The aim of this review is to present the clinical application of quantitative digital subtraction angiography (QDSA) in pediatric moyamoya disease. Using conventional angiographic data and postprocessing software, QDSA provides time-contrast intensity curves and then displays the peak time ($T_{max}$) and area under the curve (AUC). These parameters of QDSA can be used as surrogate markers for the hemodynamic evaluation of disease severity and quantification of postoperative neovascularization in moyamoya disease.

• Nuclear Medicine and Molecular Imaging
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• 제41권2호
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• pp.85-90
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• 2007

Acute event in cerebrovascular disease is the second most common cause of death in Korea following cancer, and it can also cause serious neurologic deficits. Understanding of perfusion status is important for clinical applications in management of patients with cerebrovascular diseases, and then the attacks of ischemic neurologic symptoms and the risk of acute events can be reduced. Therefore, the normal vascular anatomy of brain, various clinical applications of acetazolamide-enhanced brain perfusion SPECT, including meaning and role of assessment of vascular reserve in carotid stenosis before procedure, in pediatric Moyamoya disease before and after operation, in prediction of development of hyperperfusion syndrome before procedure, and in prediction of vasospasm and of prognosis in subarachnoid hemorrahge were reviewed in this paper.

• 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.

• Journal of Chest Surgery
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• 제36권10호
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• pp.772-775
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• 2003

모야모야 질환은 원위부 내경 동맥과 근위부 뇌동맥들의 폐쇄성 내피 이형증으로 특징지워는 뇌혈관 질환으로, 아직까지 정확한 병인이 밝혀지지 않은 질환이다. 상기 질환은 양측 내경 동맥의 원위부에 부분적인 협착이나 폐쇄를 야기하게 되고, 이러한 뇌혈관의 해부학적인 변이는 뇌의 기저부에 매우 미세한 혈관들의 문합을 형성하게 하는데, 이러한 신생 혈관들이 뇌혈관 조영검사상 구름처럼 보인다 하여 ‘Moyamoya’라 불리운다. 모야모야 환자군들에게서 관상 동맥 질환 등으로 인한 개심술의 시행은 매우 드물다고 알려져 있으며, 이러한 환자군들에서의 인공심폐기를 이용한 개심술은 수술 중, 그리고 수술 후 허혈성 뇌질환 등의 위험성이 매우 높다고 보고되고 있다. 본 교실은 모야모야 환자에서 심방중격결손 폐쇄와 관상동맥우회술을 인공심폐기를 이용한 개심술을 시행하여 성공적으로 치료하였기에 간략한 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제27권2호
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• pp.140-147
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• 1994

Reconstruction of the pharynx and cervical esophagus presents a tremendous challenges to surgeons. Over the past 2 years[1990, Dec.-1993, Jun], the free jejunal graft has been performed in 17 cases in Korea Cancer Center Hospital.The indications of this procedures were almost malignant neoplasms involving neck and upper aero-digestive tract; Hypopharyngeal cancer[12 cases, including 2 recurrent cases], laryngeal cancer[2 cases], thyroid cancer[2 cases, including 1 recurrent case], cervical esophageal cancer[1 case]. There were fifteen men and two women, and the mean age was 59.6 years. The anastomosis site of jejunal artery were common carotid artery[16 cases] or external carotid artery[1 case] and that of jejunal vein were internal jegular [15 cases] or facial[1 case] and superior thyroid vein[1 case]. The length of jejunal graft was from 9 cm to 17 cm[mean 13 cm] and the mean ischemic time was 68 minutes. There was one hospital mortality which was irrelevant to procedures[variceal bleeding] and one graft failure[1/16]. Other postoperative complications were neck bleeding or hematoma[3 cases], abdominal wound infection or disruption[5 cases], anastomosis site leakage[1 case], pneumonia[2 cases], graft vein thrombosis[1 case], and food aspiration[1 case]. The function of conduit was excellent and ingestion of food was possible in nearly all cases. Postoperative adjuvant radiation therapy was also applicable without problem in 7 cases. During follow-up periods, the anastomosis site stenosis developed in four patients, and the tracheal stoma was narrowed in one case but easily overcome with dilation. In conclusion, we think that the free jejunal graft is one of the excellent reconstruction methods of upper digestive tract, especially after radical resection of malignant neoplasm in neck with a high success rate and low mortality and morbidity rate.