• 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.

• 한국의학물리학회지:의학물리
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• 제26권4호
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• pp.215-222
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• 2015

본 연구에서는 단일 비산란 그리드 및 다색광 x-선원을 이용하여 위상대조 x-선 영상을 용이하게 구현할 수 있는 새로운 방법을 제안한다. 제안된 신기법의 개념 입증을 위해 집속형 선형 그리드(200 lines/inch 선 밀도), 마이크로 초점 x-선관(${\sim}5{\mu}m$ 초점크기), CMOS형 평판형 검출기($48{\mu}m$ 픽셀 크기)로 실험장치를 구성하였으며, 한 번의 x-선 촬영($90kV_p$, 0.1 mAs)으로 감약대조 x-선 영상과 향상된 가시성을 지진 산란 x-선 영상 및 차분 위상대조 x-선 영상을 Fourier변조복원 기법을 적용하여 성공적으로 분리 획득하였다. 더 나아가, 감약대조 x-선 영상과 산란 x-선 영상을 합성함으로써 일반 감약대조 x-선 영상에서는 명확하게 볼 수 없는 샘플의 미세 구조를 보다 선명하게 나타냄을 확인하였다. 본 논문에서 제안한 단일 비산란 그리드 기반 위상대조 x-선 영상화 기법은 실험 구성 및 절차가 단순하고 새로운 대조도에 기반한 산란 및 위상대조 x-선 영상을 동시에 제공하기 때문에 차세대 x-선 영상화 신기법으로 다양한 응용분야에서 용이하게 적용될 수 있을 것으로 전망한다.