• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.400-404
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• 2016

We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke.

• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.816-824
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• 2022

Objective : Emergency superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis in patients with large vessel occlusion who fails mechanical thrombectomy or does not become an indication due to over the time window can be done as an alternative for blood flow restoration. The authors planned this study to quantitatively measure the degree of improvement in cerebral perfusion flow using perfusion magnetic resonance imaging (MRI) after bypass surgery and to find out what factors are related to the outcome of the bypass surgery. Methods : For a total of 107 patients who underwent emergent STA-MCA bypass surgery with large vessel occlusion, the National Institute of Health stroke scale (NIHSS), modified Rankin score (mRS), infarction volume, and hypoperfusion area volume was calculated, the duration between symptom onset and reperfusion time, occlusion site and infarction type were analyzed. After emergency STA-MCA bypass, hypoperfusion area volume at post-operative 7 days was calculated and analyzed compared with pre-operative hypoperfusion area volume. The factors affecting the improvement of mRS were analyzed. The clinical status of patients who underwent emergency bypass was investigated by mRS and NIHSS before and after surgery, and changes in infarct volume, extent, degree of collateral circulation, and hypoperfusion area volume were measured using MRI and digital subtraction angiography (DSA). Results : The preoperative infarction volume was median 10 mL and the hypoperfusion area volume was median 101 mL. NIHSS was a median of 8 points, and the last normal to operation time was a median of 60.7 hours. STA patency was fair in 97.1% of patients at 6 months follow-up DSA and recanalization of the occluded vessel was confirmed at 26.5% of patients. Infarction volume significantly influenced the improvement of mRS (p=0.010) but preoperative hypoperfusion volume was not significantly influenced (p=0.192), and the infarction type showed marginal significance (p=0.0508). Preoperative NIHSS, initial mRS, occlusion vessel type, and last normal to operation time did not influence the improvement of mRS (p=0.272, 0.941, 0.354, and 0.391). Conclusion : In a patient who had an acute cerebral infarction due to large vessel occlusion with large ischemic penumbra but was unable to perform mechanical thrombectomy, STA-MCA bypass could be performed. By using time-to-peak images of perfusion MRI, it is possible to quickly and easily confirm that the brain tissue at risk is preserved and that the ischemic penumbra is recovered to a normal blood flow state.

• The Journal of Korean Medicine
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• v.20 no.1 s.37
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• pp.161-171
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• 1999

This study was performed to investigate the effect of complex formula(CKRG) consisting of Panax ginseng Radix rubra Koreana. Ganoderma, Cinnamomi Cortex, Glycyrrhizae Radix and Laminariae Thallus on brain ischemia and injury such as KCN-induced brain injury, forced brain ischemia, pulmonary thrombosis. The results were summarized as follows: 1. CKRG extracts showed a decrease of the duration of KCN-induced coma and showcd an increase in life expectancy. 2. CKRG extracts showed a decrease of neurologic grade in hind limb but did not affect neurologic grades in fore limb. Also. CKRG extracts showed a significant decrease of brain ischemic area and edema in MCA occlusion, 3. CKRG extracts showed a protective effect on pulmonary thrombosis induced by collagen and epinephrine. These data suggested that CKRG extracts could be applied to the protection of brain ischemia and injury.

• Journal of Korean Neurosurgical Society
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• v.48 no.2
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• pp.105-108
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• 2010

Objective : Some neurosurgeons intentionally ligate the branches of the superficial temporal artery (STA) that are not used in standard STA-to-middle cerebral artery (MCA) anastomosis for the purpose of improving the flow rate in the bypass graft. We investigated changes in bypass flow during temporary occlusion of such unused branches of the STA. Methods : Bypass blood flow was measured by a quantitative microvascular ultrasonic flow probe before and after temporary occlusion of branches of the STA that were not used for anastomosis. We performed measurements on twelve subjects and statistically assessed changes in flow. We also examined all the patients with digital subtraction angiography in order to observe any post-operative changes in STA diameter. Results : Initial STA flow ranged from 15 mL/min to 85 mL/min, and the flow did not change significantly during occlusion as compared with preocclusion flow. The occlusion time was extended by 30 minutes in all cases, but this did not contribute to any significant flow change. Conclusion : The amount of bypass flow in the STA seems to be influenced not by donor vessel status but by recipient vessel demand. Ligation of the unused STA branch after completion of anastomosis does not contribute to improvement in bypass flow immediately after surgery, and furthermore, carries some risk of skin necrosis. It is better to leave the unused branch of the STA intact for use in secondary operation and to prevent donor vessel occlusion.

• The Journal of Korean Medicine
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• v.30 no.2
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• pp.117-126
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• 2009

Objectives: This study was performed to investigate the effects of Semen Persicae (SP) on infarct volume, COX-2 protein expression in the middle cerebral artery occlusion (MCAo) rats. Methods: Twenty-eight rats were randomly assigned to four groups (MCAo experimental group, MCAo control group, sham experimental group, control group). The middle cerebral artery (MCA) was occluded in the MCAo group by proximal focal cerebral ischemia rat model, while the MCA was not occluded in the sham group. SP extraction was administrated for 4 days to each experimental group. Neuroprotective effects were investigated by measurement of brain damage using 2, 3, 5-triphenyltetrazolium chloride staining and analysis of COX-2 protein expression by western blotting. Results: The occurrence of infarct volume in the SP oral administration group decreased compared to the control group. COX-2 protein expression in the SP oral administration group decreased compared to the control group. Conclusions: The present study demonstrates the effect of SP in reducing infarct volume and decreasing COX-2 expression.

• Journal of Physiology & Pathology in Korean Medicine
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• v.18 no.1
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• pp.265-273
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• 2004

KBPTS is the fortified prescription of Bang-pung-tong-sung-san (BPTS) by adding Spatholobi Clulis and Salviae Miltiorrzae Radix. BPTS prescription has been used in Qriental medicine for the treatments of vascular diseases including hypertension, stroke, and arteriosclerosis, and nervous system diseases. Yet, the overall mechanism underlying its activity at the cellular levels remains unknown. To investigate the protective role of KBPTS on brain functions, noxious stimulations were applied to neurons in vitro and in vivo. KBPTS pretreatment in cultured cortical neurons of albino ICR mice rescued death caused by AMPA, NMDA, and kainate as well as by buthionine sulfoximine (BSO) and ferrous chloride (Fe/sup 2+/) treatments. Furthermore, KBPTS promoted animal's recovery from coma induced by a sublethal dose of KCN and improved survival by a lethal dose of KCN. To examine its physiological effects on the nervous system, we induced ischemia in the Sprague-Dawley rat's brain by middle cerebral artery (MCA) occlusion. Neurological examination showed that KBPTS reduced the time which is required for the animal after MCA occlusion to respond in terms of forelimb and hindlimb movement$. Histological examination revealed that KBPTS reduced ischemic area and edema rate and also protected neurons in the cerebral cortex and hippocampus from ischemic damage. Thus, the present data suggest that KBPTS may play an important role in protecting neuronal cells from external noxious stimulations.

• The Journal of Korean Medicine
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• v.24 no.3
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• pp.72-83
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• 2003

Objective : The goal of the present study was to investigate the protective effect of Gamiheechum-tang (Jiaweixiqian-tang; GHCT) on brain tissue damage from chemical or ischemic insults. Methods : Levels of cultured cortical neuron death caused by toxic chemicals were measured by LDH release assay. Neuroprotective effects of GHCT on brain tissues were examined in vivo by ischemic model of middle cerebral artery (MCA) occlusion. Results : Animal groups treated with GBCT showed significantly decreased hypertension, and reduced levels of aldosterone, dopamine, and epinephrine in the plasma. GHCT treatments ($l0-200\mu\textrm{g}/ml$) significantly decreased cultured cortical neuron death mediated by AMPA, kainate, BSO, or Fe2+ when measured by LDH release assay. Yet, cell death mediated by NMDA was effectively protected by GHCT at the highest concentration examined ($200\mu\textrm{g}/ml$). In the in vivo experiment examining brain damage by MCA occlusion, affected brain areas by ischemic damage and edema were significantly less in animal groups administered with GHCT compared to the non-treated control group. Neurological examinations of forelimbs and hindlimbs showed that GHCT treatment improved animals' recovery from ischemic injury. Moreover, the extent of injury in cortical and hippocampal pyramidal neurons in ischemic rats was much reduced by GHCT, whose morphological features were similarly observed in non-ischemic animals. Conclusion : The present data suggest that GBCT may play an important role in protecting brain tissues from chemical or ischemic injuries.

• The Journal of Korean Medicine
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• v.23 no.3
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• pp.134-144
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• 2002

Objective : The purpose of this study was to investigate the effect of Jukryuk and Saengkang-juices on cerebral vascular ischemia (CVI) of the middle cerebral artery (MCA). Method : By admiuistration Jukryuk and Saengkang-juices, we compared treated groups with untreated groups, in view of five points as follows: 1) cerebral damage; 2) damaged area of ischemia; 3) cerebral edema; 4) the number of neuronal cells adjacent to the areas damaged by ischemia; and 5) the number of neuronal cells adjacent to the areas damaged by ischemia Results : In this experiment, the effect of Jukryuk and Saengkang-juices was determined by inducing cerebral vascular ischemia after occluding the middle cerebral artery (MCA) in mice, and making observations and comparisons such as alterations in damaged areas and neuronal cellular changes in the brain. Conclusions : According to the above results, Jukryuk and Saengkang-juices can protect the cerebral vascular ischemia.

• The Journal of Korean Medicine
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• v.18 no.1
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• pp.337-343
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• 1997

With the purpose of producing easily the basal ganglia infarction into Chen's, scerebral ischemic model which is almost cortical infarct made by the ligation of distal part of MCA and 1 hr obliteration of both common carotid arteries in rat, the MCA obstruction was extended between rhinal fissure and olfactory tract with electrocauterization in place of 10-0 silk suture ligation of distal part of MCA. Both original Chen's model and modified Chen's have shown the cortical infarction in dorsolateral & lateral frontoparietal cortex, but not any infarction in basal ganglia. However, the modified Chen's model have shown the effect of average 12% increase in cortical infarct than that of original Chen's model. This experimental results suggest the modified Chen's model can not reduce the blood flow of the lateral lenticulostriatal artery enough to make the basal ganglia infarction and that blood circulation of basal gagglia under its condition is probably being kept partly through the posterior cerebral artery via vertebral artery. Therefore, The follow-up observation on ischemic time lapse would be needed.

• Journal of Korean Neurosurgical Society
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• v.46 no.5
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• pp.488-491
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• 2009

A 31-year-old man presented with right hemiparesis, and magnetic resonance imaging revealed a small infarct at left basal ganglia. Digital subtraction angiography showed left cervical internal carotid artery (ICA) occlusion and severe stenosis of the ipsilateral external carotid artery (ECA) with collateral cerebral circulation fed by ECAs. Based on the results of a functional evaluation of cerebral blood flow, we performed preventive ECA angioplasty and stenting for advanced ECA stenosis to ensure sufficient blood flow to the superficial temporal artery. Eight weeks later, superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was performed. His postoperative course was uneventful and no additional transient ischemic attacks have occurred. To our knowledge, this is the first report of preventive angioplasty and stenting for advanced narrowing of an ECA before STA-MCA anastomosis for ipsilateral ICA occlusion.