• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• 제25권1호
• /
• pp.36-49
• /
• 2023

Objective: Arteriovenous malformations (AVMs) are benign congenital lesions. The estimated prevalence is 10-18 per 100,000 individuals, with an incidence rate of 1.1-1.4 per 100,000 person-year; only 12% of AVMs present symptoms during life. It is important to study different characteristics associated with AVMs because these patients require multidisciplinary treatment. Methods: A descriptive, observational, longitudinal, and retrospective study was carried out from January 15, 2016 to October 19, 2021. Convenience sampling was used on patients diagnosed with arteriovenous malformation. Sociodemographic data was obtained, such as: sex, age, site, predominant symptoms, clinical debut, type of malformation, data associated with post therapy evolution, type of embolizing agent used, associated complications, Rankin scale, and death. Results: Data from 535 procedures was collected, we calculated an incidence of 4.4 cases per million inhabitants. Ninety procedures in 56 patients that used endovascular therapy were obtained with a female-male ratio of 0.75 and an age distribution of 35±14 (SD). A 36.3±11.5 (SD) mm diameter was registered. There was a 33% success rate for endovascular surgery. Conclusions: The multidisciplinary treatment of AVMs is made up of three pillar techniques: microsurgical resection, embolization, and radio-neurosurgery. It is extremely important to make an appropriate decision, with an emphasis on achieving better functional outcomes for the patient. Although neurological endovascular therapy was initially used as an adjuvant treatment for neurosurgery and radio-neurosurgery, it has been used more and more frequently as the first line of treatment.

• Vascular Specialist International
• /
• 제34권4호
• /
• pp.117-120
• /
• 2018

The endovascular recanalization of the iliocaval system has replaced venous surgical reconstructions as the primary treatment option in severe post-thrombotic syndrome (PTS). We herein present a 51-year-old female with previous deep venous thrombosis, complicated with PTS with a large and complex circumferential calf ulcer measuring 25 cm of length in the left lower extremity. Venogram revealed a complete and extensive occlusion in the left iliofemoral system. A surgical bypass from the left common femoral vein to the right common iliac vein was performed. Patient recovered well and after 12 months postoperation her large wound is healing favorably with a clean and well granulated bed. Iliofemoral venous bypass is a feasible treatment for non-healing ulcer of lower extremity.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• 제25권3호
• /
• pp.333-339
• /
• 2023

Aortic dissection is one of the causes of acute ischemic stroke. Endovascular recanalization therapy (EVT) has emerged as an essential treatment for acute ischemic stroke due to large artery occlusion. However, it is rarely performed in the situation of hidden aortic dissection (AD). Two patients presented to the emergency room with focal neurologic deficits. The first patient was diagnosed with right internal carotid artery (ICA) occlusion. Angiography revealed that the ICA was occluded by the dissection flap. After a stent deployment in the proximal ICA, the antegrade flow was restored. The patient was diagnosed with AD on chest computed tomography (CT) after EVT. For the second patient, intraarterial thrombectomy was performed to treat left middle cerebral artery occlusion. AD was first detected on echocardiography, which was performed after EVT. Herein, we report successful endovascular recanalization therapy performed in two patients with acute ischemic stroke in the situation of undiagnosed aortic dissection. We also reviewed previous case reports and relevant literature.

• 임상간호연구
• /
• 제19권1호
• /
• pp.69-80
• /
• 2013

Purpose: This study aimed to prove the effect of exercise therapy on discomfort and low back pain after cerebral endovascular surgery through femoral artery. Methods: The study employed a non-equivalent control group pretest-posttest design. Data were collected from 74 participants and were divided equally into two groups as experimental and control groups. In the experimental group, exercise therapy was applied in 2 hours, 4 hours, and 6 hours after cerebroendovascular surgery. The level of discomfort, back pain, hemorrhage, and hematoma was observed and recorded as a pretest. In the posttest, low back pain, hemorrhage, and hematoma were measured in 2.5 hours, 4.5 hours, and 6.5 hours, and discomfort was measured in 6.5 hours. The study was conducted from April to September, 2012. Data were analyzed with descriptive study, Chi-square test, t-test, repeated measure ANOVA and Bonferroni using SPSS/WIN 18.0 version. Results: The exercise therapy after cerebral endovascular surgery helps in reducing the level of discomfort (t=-2.37, p=.020) and low back pain (F=5.15, p=.005) without the side effects of hemorrhage or hematoma. Conclusion: Therefore, the exercise therapy was an efficient intervention for patients after cerebral endovascular surgery with discomfort and low back pain. Nurses could apply non-pharmacological interventions such as exercise therapy to avoid pharmacological side-effects.

• Journal of Korean Neurosurgical Society
• /
• 제43권1호
• /
• pp.21-25
• /
• 2008

Objective : Both endovascular coil embolization and microsurgical clipping are now firmly established as treatment options for the management of cerebral aneurysms. Moreover, they are sometimes used as complementary approaches each other. This study retrospectively analyzed our experience with endovascular and microsurgical procedures as complementary approaches in treating a single aneurysm. Methods : Nineteen patients with intracranial aneurysm were managed with both endovascular and microsurgical treatments. All of the aneurysms were located in the anterior circulation. Eighteen patients presented with SAH, and 14 aneurysms had diameters of less than 10 mm, and five had diameters of 10-25 mm. Results : Thirteen of the 19 patients were initially treated with endovascular coil embolization, followed by microsurgical management. Of the 13 patients, 9 patients had intraprocedural complications during coil embolization (intraprocedural rupture, coil protrusion, coil migration), rebleeding with regrowth of aneurysm in two patients, residual sac in one patient, and coil compaction in one patient. Six patients who had undergone microsurgical clipping were followed by coil embolization because of a residual aneurysm sac in four patients, and regrowth in two patients. Conclusion : In intracranial aneurysms involving procedural endovascular complications or incomplete coil embolization and failed microsurgical clipping, because of anatomical and/or technical difficulties, the combined and complementary therapy with endovascular coiling and microsurgical clipping are valuable in providing the best outcome.

• Journal of Korean Neurosurgical Society
• /
• 제39권4호
• /
• pp.300-302
• /
• 2006

"Stunning" represents prolonged contractile depression of any muscular component after alleviation of severe ischemia, as shown in reperfusion following acute myocardial ischemia or ischemic stroke. Clinically, it presents with no or delayed recovery past to thrombolytic therapy but its pathogenic mechanism is not fully uncovered yet. We describe a unique case of a 63-year-old woman, who was undertaken endovascular coiling for the aneurysms, deteriorated several hours later without known cause, and showed delayed clinical improvement over the next 3 days following thrombolysis. Immediate post-thrombolysis magnetic resonance imaging scan showed no apparent abnormality except for high signal intensity within the corresponding hemisphere. Reversible but delayed nature of " brain stunning" can be explained by these images and it seems to be caused by a certain type of reperfusion injury.

• Korean Journal of Radiology
• /
• 제20권5호
• /
• pp.739-748
• /
• 2019

For recanalization of emergent large vessel occlusions (ELVOs), endovascular therapy (EVT) using newer devices, such as a stent retriever and large-bore catheter, has shown better patient outcomes compared with intravenous recombinant tissue plasminogen activator only. Intracranial atherosclerotic stenosis (ICAS) is a major cause of acute ischemic stroke, the incidence of which is rising worldwide. Thus, it is not rare to encounter underlying ICAS during EVT procedures, particularly in Asian countries. ELVO due to underlying ICAS is often related to EVT procedure failure or complications, which can lead to poor functional recovery. However, information regarding EVT for this type of stroke is lacking because large clinical trials have been largely based on Western populations. In this review, we discuss the unique pathologic basis of ELVO with underlying ICAS, which may complicate EVT procedures. Moreover, we review EVT data for patients with ELVO due to underlying ICAS and suggest an optimal endovascular recanalization strategy based on the existing literature. Finally, we present future perspectives on this subject.

• Journal of Korean Neurosurgical Society
• /
• 제44권6호
• /
• pp.364-369
• /
• 2008

Objective : The aim of this study was to evaluate the efficacy of endovascular therapy as a primary treatment for spinal dural arteriovenous fistula (DAVF). Methods : The authors reviewed 18 patients with spinal DAVFs for whom endovascular therapy was considered as an initial treatment at a single institute between 1993 and 2006. NBCA embolization was considered the primary treatment of choice, with surgery reserved for patients in whom endovascular treatment failed. Results : Surgery was performed as the primary treatment in one patient because the anterior spinal artery originated from the same arterial pedicle as the artery feeding the fistula. Embolization was used as the primary treatment modality in 17 patients. with an initial success rate of 82.4%. Two patients with incomplete embolization had to undergo surgery. One patient underwent multiple embolizations, which failed to completely occlude the fistula but relieved the patient's symptoms. Spinal DAVF recurred in two patients (one collateral development and one recanalization) during the follow-up period. The collateral development was obliterated by repeated embolization, but the patient with recanalization refused further treatment. The overall clinical status improved in 15 patients (83.3%) during the follow-up period. Conclusion : Endovascular therapy can be successfully used as a primary treatment for the majority of patients with spinal DAVFs. Although it is difficult to perform in some patients, endovascular embolization should be the primary treatment of choice for spinal DAVF.

• Journal of Korean Neurosurgical Society
• /
• 제60권3호
• /
• pp.335-347
• /
• 2017

Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays. Huge progress was made in 2015, as there were five randomized clinical trials which all demonstrated the safety and efficacy of endovascular stroke treatment. Despite differences in detail patient enrollment criteria, all 5 trials employed key factors for good functional recovery; (1) screening with non-invasive imaging to identify the proximal occlusion and exclude a large infarct core, (2) using highly effective modern thrombectomy devices mainly with stent retriever, and (3) establishment of a fast workflow to achieve effective reperfusion. The results of those trials indicate that modern thrombectomy devices can allow for faster and more effective reperfusion, which can lead to improved clinical outcomes compared to intravenous thrombolysis alone. These advances in mechanical thrombectomy are promising in the global fight against ischemic stroke-related disability and mortality. Two current mainstreams among such mechanical thrombectomy techniques, "stent retriever thrombectomy" and "direct clot aspiration", are the topic of this review. Stent retriever thrombectomy using Solitaire and Trevo retriever will be firstly discussed. And, the commonalities and the differences between two major clot aspiration thrombectomy techniques; a direct aspiration first pass technique (ADAPT) and forced arterial suction thrombectomy (FAST), will be additionally explained. Finally, details regarding the combination of direct clot aspiration and stent retriever thrombectomy, the switching strategy and the Solumbra technique, will be described.

• Journal of Chest Surgery
• /
• 제45권6호
• /
• pp.390-395
• /
• 2012

Background: Conventional open repair is a suboptimal therapy for blunt traumatic aortic injury (BTAI) due to the high postoperative mortality and morbidity rates. Recent advances in the thoracic endovascular repair technique may improve outcomes so that it becomes an attractive therapeutic option. Materials and Methods: From August 2003 to March 2012, 21 patients (mean age, 45.81 years) with BTAI were admitted to our institution. Of these, 18 cases (open repair in 11 patients and endovascular repair in 7 patients) were retrospectively reviewed and the early perioperative results of the two groups were compared. Results: Although not statistically significant, there was a trend toward the reduction of mortality in the endovascular repair group (18.2% vs. 0%). There were no cases of paraplegia or endoleak. Statistically significant reductions in heparin dosage, blood loss, and transfusion amounts during the operations and in procedure duration were observed. Conclusion: Compared with open repair, endovascular repair can be performed with favorable mortality and morbidity rates. However, relatively younger patients who have acute aortic arch angulation and a small aortic diameter may be a therapeutic challenge. Improvements in graft design, delivery sheaths, and graft durability are the cornerstone of successful endovascular repair.