• Journal of Chest Surgery
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• 제37권4호
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• pp.369-372
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• 2004

인공판막 혈전에 의한 관상동맥 폐쇄 후 발생하는 급성심근경색은 드물지만 치명적인 질환으로 환자들의 생존율을 높이기 위해서는 빠른 진단과 적절한 치료가 중요하다 본원에서는 기계승모판막 혈전에 의한 좌전하행지의 폐쇄로 급성심근경색이 발생한 환자 1예에서 중재시술 및 항혈전요법 후 승모판 재치환술을 성공적으로 시행하였기에 증례 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.252-255
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• 2011

Authors report a case of a painless acute dissecting aneurysm of the descending aorta in a patient who presented with unexplained hypotension followed by simultaneous paraplegia and right arm monoparesis. To our knowledge, case like this has not been reported previously. Magnetic resonance imaging of the brain and spine revealed hemodynamic cerebral infarction and extensive cord ischemia, respectively. Computerized tomography angiography confirmed a dissecting aneurysm of the descending aorta. The cause of the brain infarction may not have been embolic, but hemodynamic one. Dissection-induced hypotension may have elicited cerebral perfusion insufficiency. The cause of cord ischemia may be embolic or hemodynamic. The dissected aorta was successfully replaced into an artificial patch graft. The arm monoparesis was improved, but the paraplegia was not improved. In rare cases of brain and/or spinal cord infarction caused by painless acute dissecting aneurysm of the aorta, accurate diagnosis is critical because careless thrombolytic therapy can result in life-threatening bleeding.

• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.42-49
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• 2024

Objective : There is still controversy regarding whether neck remodeling stent affects the occurrence of silent embolic infarction (SEI) after aneurysm coiling. Thus, the aim of the present study is to investigate the incidence of SEI after stent-assisted coiling (SAC) using Neuroform Atlas Stent (NAS) and possible risk factors. This study also includes a comparison with simple coiling group during the same period to estimate the impact of NAS on the occurrence of SEI. Methods : This study included a total of 96 unruptured intracranial aneurysms in 96 patients treated with SAC using NAS. Correlations of demographic data, aneurysm characteristics, and angiographic parameters with properties of SEI were analyzed. The incidence and characteristics of SEI were investigated in 28 patients who underwent simple coiling during the same period, and the results were compared with the SAC group. Results : In the diffusion-weighted imaging obtained on the 1st day after SAC, a total of 106 SEI lesions were observed in 48 (50%) of 96 patients. Of these 48 patients, 38 (79.2%) had 1-3 lesions. Of 106 lesions, 74 (69.8%) had a diameter less than 3 mm. SEI occurred more frequently in older patients (≥60 years, p=0.013). The volume of SEI was found to be significantly increased in older age (≥60 years, p=0.032), hypertension (p=0.036), and aneurysm size ≥5 mm (p=0.047). The incidence and mean volume of SEI in the SAC group (n=96) were similar to those of the simple coiling group (n=28) during the same period. Conclusion : SEIs are common after NAS-assisted coiling. Their incidence in SAC was comparable to that in simple coiling. They occurred more frequently at an older age. Therefore, the use of NAS in the treatment of unruptured intracranial aneurysm does not seem to be associated with an increased risk of thromboembolic events if antiplatelet premedication has been performed well.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.316-320
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• 2015

Objective : The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device. Methods : From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ${\geq}70%$ were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates. Results : CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group). Conclusion : Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.

• Journal of Korean Neurosurgical Society
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• 제45권6호
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• pp.394-396
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• 2009

Cerebral embolic infarction is the most common neurologic complication of cardiac myxoma (CM). Development of cerebral aneurysms in CM is very rare. We present a 64-year-old woman with acute cerebral infarction and multiple cerebral aneurysms complicated by CM. The aneurysms were multiple, fusiform-shaped, and located in distal branch of major cerebral arteries. The serum interleukin (IL)-6 was highly elevated, which was normalized after surgical resection of CM. There was no regression of aneurysms on follow-up neuroimaging. Multiple cerebral aneurysms in CM are rare condition. Highly elevated serum IL-6 may be associated with increased risk of cerebral aneurysmal formation.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.763-775
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• 2021

Objective : Hemorrhagic transformation (HT) can be occurred after acute cerebral infarction. HT can worse symptoms in severe cases and adversely affect long-term prognosis. As bone and vascular smooth muscle are composed of type 1 collagen, we aimed to identify a potential relationship between bone mineral density (BMD) and HT after acute cardioembolic stroke. Methods : As an indicator of BMD, we used mean frontal skull Hounsfield unit (HU) values on brain computed tomography (CT). Multivariative hazard ratios were calculated using Cox regression analysis to identify whether the osteoporotic condition was an independent predictor of HT after acute cardioembolic stroke. Results : This 11-year analysis enrolled 506 patients who diagnosed as acute cardioembolic infarction. The first tertile of skull HU value was an independent predictor of HT development compared to the third tertile (hazard ratio, 2.12; 95% confidence interval, 1.13-3.98; p=0.020). We observed no interactions between age and skull HU with respect to HT statistically. Conclusion : The results of this study revealed an association between osteoporotic conditions and HT development after acute cardioembolic stroke. A convenient method to measure the cancellous bone HU value of the frontal skull using brain CT images may be useful for predicting HT in patients with acute cerebral infarction.

• Journal of Yeungnam Medical Science
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• 제12권1호
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• pp.96-104
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• 1995

여러가지 색전물질이 조직내에서 어떤 변화를 야기시키며 또한 시간경과에 따라 어떤 변화를 보이게 되는지를 알아보기 위해 EVAL, Histoacryl, Ivalon을 이용하여 토끼의 신동맥을 통해 색전을 실시하였으며 시간경과에 따라 조직학적으로 검사하여 다음과 같은 결과를 얻었다. EVAL은 1주일이내의 초기단계에는 혈관 내에서 별다른 조직변화를 일으키지 않았으나 2주일 이내의 중기단계에는 혈관벽의 비후를 나타냈다. Histoacryl은 1주일이내의 초기단계에 벌써 심한 섬유소양 변성을 보여 심한 조직변화를 일으킨다는 것을 알 수 있었고 실험 예의 반수에서 신동맥의 폐쇄에 의한 경색을 볼 수 있어 강한 조직유착성을 시사해 주었으며 실제 환자에 적용함에 있어 주의를 환기시켜 주었고 혈류가 빠르거나 누공등이 있는 경우에 더욱 적절히 사용될 수 있음을 알 수 있었다. Ivalon은 초기에는 혈관염의 소견을, 중기에는 이물질반응에 의한 거대세포를, 후기에는 심한 섬유화의 소견을 보여 주었고 수술을 대신하는 치료적인 목적보다는 혈류를 줄여 수술을 보다 용이하게 해주는 등 수술의 보조적인 이용에 바람직할 것으로 기대된다.

• Journal of Korean Neurosurgical Society
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• 제50권2호
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• pp.89-94
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• 2011

Objective : D-dimer is a breakdown product of fibrin mesh after factor XIII stabilization. Previously, many authors have demonstrated a relationship between D-dimer level and stroke progression or type. This study aimed to investigate the relationship between D-dimer level and stroke volume. Methods : Between January 2008 and December 2009, we analyzed the D-dimer levels of 59 acute ischemic stroke patients in our neurosurgical department both upon admission and after seven days of initial treatment. Each patient's National Institute of Health Stroke Scale score, modified Rankin Scales score, Glasgow outcome score, and infarction volume were also evaluated. Results : Mean D-dimer level at admission was 626.6 ${\mu}g/L$ (range, 77-4,752 ${\mu}g/L$) and the mean level measured after seven days of treatment was 238.3 ${\mu}g/L$ (range, 50-924 ${\mu}g/L$). Mean D-dimer level at admission was 215.3 ${\mu}g/L$ in patients with focal infarctions, 385.7 ${\mu}g/L$ in patients with multiple embolic infarctions, 566.2 ${\mu}g/L$ in those with 1-19 cc infarctions, 668.8 ${\mu}g/L$ in 20-49 cc infarctions, 702.5 ${\mu}g/L$ in 50-199 cc infarctions, and 844.0 ${\mu}g/L$ in >200 cc infarctions (p=0.044). On the 7th day of treatment, the D-dimer levels had fallen to 201.0 ${\mu}g/L$, 293.2 ${\mu}g/L$, 272.0 ${\mu}g/L$, 232.8 ${\mu}g/L$, 336.6 ${\mu}g/L$, and 180.0 ${\mu}g/L$, respectively (p=0.530). Conclusion : Our study shows that D-dimer level has the positive correlation with infarction volume and can be use to predict infarction-volume.

• Journal of Korean Neurosurgical Society
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• 제65권4호
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• pp.603-608
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• 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.

• Investigative Magnetic Resonance Imaging
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• 제6권2호
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• pp.158-165
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• 2002

목적: 체내에 주입된 Gd-DTPA가 뇌의 확산강조 자기공명영상 신호강도 및 현성확산계수에 미치는 영향을 알아보았다. 대상 및 방법 : 성숙한 잡견 5마리에 대하여 동맥내 도관삽입에 의한 좌측 내경동맥 색전방법을 이용하여 초급성 뇌경색 동물모델을 만들었다. 색전 후 1시간째 확산강조영상을 시행하고, Gd-DTPA를 주입한 다음 다시 90분까지 11회의 추가 확산강조영상을 얻었다. 관심영역을 설정하여 측정한 초급성 뇌경색부위와 반대측 정상부위의 확산강조영상 신호강도 및 현성확산계수를 분석하였다. 결과: 뇌경색은 색전 후 1시간에 시행한 확산강조 자기공명영상에서 잡견 5마리 모두에서 발견되었다. 확산강조영상에서 초급성 뇌경색부위의 신호강도는 Gd-DTPA 주입 여부와 관계없이 시간이 경과함에 따라 증가하였으나, 관류가 유지된 정상부위의 신호강 도는 Gd-DTPA 주입 후 2분에 시행한 첫 검사에서 오히려 저하된 후, 시간경과에 따라 다시 증가하였다. 현성확산계수는 초급성 뇌경색부위에서 Gd-DTPA주입여부에 관계없이 시간 이 경과함에 따라 지속적으로 감소되었으나, 관류가 유지된 반대측 정상부위에서는 변화하지 않았다. 결론: 체내에 주입된 Gd-DTPA는 초급성 뇌경색부위 및 정상부위의 현성확산계수에 영향을 미치지 않으나, 정상부위에서는 조영제 주입 직후 초기의 자화율효과에 의해 확산강조영상의 신호 강도를 저하시켰다. 조영제 주입 후 시행한 확산강조영상 신호 강도의 정량적인 측정이 필요한 연구 혹은 임상 증례에 대하여는 현성확산계수를 측정함으로써 Gd-DTPA의 자화율효과에 의한 영향을 배제하여야 할 것이다.