• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.352-356
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• 2016

Objective : The efficacy and safety of manual aspiration thrombectomy using Penumbra in an acute occlusion of large intracranial arteries has been proven in many previous studies. Our study aimed to retrospectively assess the efficacy and safety of manual aspiration thrombectomy using Penumbra in patients with small vessel occlusions (M2 segment of the MCA). Methods : We conducted a retrospective review of 32 patients who underwent manual aspiration thrombectomy using the Penumbra 4 MAX Reperfusion Catheter for treatment of an M2 occlusion between January 2013 and November 2014. We evaluated immediate angiographic results and clinical outcomes through review of patient electronic medical records. Results : There were slightly more men in this study (M : F=18 : 14) and the median age was 72.5 (age range : 41-90). The rate of successful recanalization (TICI grade ${\geq}2b$) was 84% (27/32). NIHSS at discharge and favorable clinical outcomes at 3 months were significantly improved than baseline. Median initial NIHSS score was 10 (range : 4-25) and was 4 (range : 0-14) at discharge. Favorable clinical outcomes (mRS score ${\leq}2$ at 3 months) were seen in 25 out of 32 patients (78%). There were no procedure-related symptomatic intracerebral hemorrhages. One patient expired after discharge due to a cardiac problem. Conclusion : Manual aspiration thrombectomy might be safe and is capable of achieving a high rate of successful recanalization and favorable clinical outcomes in patients with distal cerebral vessel occlusion (M2).

• Journal of Chest Surgery
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• v.37 no.3
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• pp.220-227
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• 2004

The number of patients with coronary artery disease and peripheral vascular disease are increasing, and the need of small diameter vessel is also increasing. We developed small diameter artificial vessel and experimented in vivo. We got allogenic valve from mongrel dogs, and removed all cells from the allogenic valve. Then, we seeded autologous bone marrow cells onto the decellularized scaffold. After implantation of artificial vessel into the canine carotid artery, we performed angiography regularly. In case of vessel occlusion or at 8 weeks after operation, we euthanized dogs, and retrieved the implanted artificial vessels. Control vessels were all occluded except one (which developed aneurysmal dilatation). But autologous cell seeded vascular graft were patent by 4 weeks in one, by 6 in one and by 8 weeks in two. Histologic examination of patent vessel revealed similar structure to native artery. Tissue-engineered vascular graft manufactured with decellularized allogenic matrix and autologous bone marrow cells showed that tissue engineered graft had similar structure to native artery.

• Journal of Korean Neurosurgical Society
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• v.48 no.1
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• pp.53-58
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• 2010

Objective : The purpose of this study was to review the safety and durability of aneurysms treated with stent-assisted coiling of ruptured anterior communicating artery aneurysms with small parent vessels (< 2.0 mm). Methods : Retrospective review of all ruptured aneurysm treated with stent assisted endovascular coiling between March 2005 and March 2009 at our institution was conducted. We report 11 cases of the Neuroform stent placement into cerebral vessels measuring less than 2.0 mm in diameter (range, 1.3-1.9 mm) in anterior cerebral artery. Clinical follow-up ranged from 3 to 12 months and imaging follow-up was performed with cerebral angiography at 6 months and 12 months after discharge. Results : Complete occlusion was achieved in 10 patients, and a remnant neck was evident in one. No stent displacement or no dislodgement occurred during stent placement. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. We performed follow-up angiography in all patients at 6 months and/or 12 months from the first procedure. The follow-up angiographic data showed successfully results except one in-stent stenosis case. All patients improved clinical performances except one patient with severe vasospasm who showed poor clinical condition initially. Conclusion : We have safely and successfully treated 11 vessels smaller than 2.0 mm in diameter with self-expanding stents with good short and intermediate term results. More clinical data with longer follow-ups are needed to establish the role of stent-assisted coiling in ruptured aneurysms with small parent vessels.

• BMB Reports
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• v.42 no.9
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• pp.617-622
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• 2009

We investigated the genetic associations of ischemic stroke by identifying epistasis of its heterogeneous subtypes such as small vessel occlusion (SVO) and large artery atherosclerosis (LAA). Epistasis was analyzed with 24 genes in 207 controls and 271 patients (SVO = 110, LAA = 95) using multifactor dimensionality reduction and entropy decomposition. The multifactor dimensionality reduction analysis with any of 1- to 4-locus models showed no significant association with LAA (P > 0.05). The analysis of SVO, however, revealed a significant association in the best 3-locus model with P10L of TGF-$\beta{1}$, C1013T of SPP1, and R485K of F5 (testing balanced accuracy = 63.17%, P < 0.05). Subsequent entropy analysis also revealed that such heterogeneity was present and quite a large entropy was estimated among the 3 loci for SVO (5.43%), but only a relatively small entropy was estimated for LAA (1.81%). This suggests that the synergistic epistasis model might contribute specifically to the pathogenetsis of SVO, which implies a different etiopathogenesis of the ischemic stroke subtypes.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.160-169
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• 2008

Bakcground: To treat anastomosis site stenosis and occlusion of the artificial vessels used in vascular surgery, tissue-engineered artificial vessels using autologous cells have been constructed. We developed artificial vessels using a polymer scaffold and autologous bone marrow cells and performed an in vivo evaluation. Material and Method: We manufactured a vascular scaffold using biodegradable PLCL (poly lactide-co-${\varepsilon}$-caprolactone) and PGA (poly glycolic acid) fibers. Then we seeded autologous bone marrow cells onto the scaffold. After implantation of the artificial vessel into the abdominal aorta, we performed an angiography 3 weeks after surgery. After the dogs were euthanized we retrieved the artificial vessels and performed histological analysis. Result: Among the six dogs, 2 dogs died of massive bleeding due to a crack in the vascular scaffold 10 days after the operation. The remaining four dogs lived for 3 weeks after the operation. In these dogs. the angiography revealed no stenosis or occlusion at 3 weeks after the operation. Gross examination revealed small thrombi on the inner surface of the vessels and the histological analysis showed three layers of vessel structure similar to the native vessel. Immunohistochemical analysis demonstrated regeneration of the endothelial and smooth muscle cell layers. Conclusion: A tissue engineered vascular graft was manufactured using a polymer scaffold and autologous bone marrow cells that had a structure similar to that of the native artery. Further research is needed to determine how to accommodate the aortic pressure.

• The Journal of Internal Korean Medicine
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• v.28 no.4
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• pp.896-901
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• 2007

Objectives : This study aimed to evaluate the characteristics of patients with single infarction and multiple infarctions. Method : We studied inpatients who were admitted from 2005/10/1 to 2007/3/30 at the KyungHee University Oriental Medical Center (KOMC) Department of Cardiovascular & Neurology (stroke center). We sorted small vessel occlusion patients and evaluated general characteristics of the patients along with the characteristics of single and multiple infarction patients. Result : We evaluated 262 inpatients, and did not find any significant difference in age, hypertension, diabetes, hyperlipidemia, diet, exercise, homocysteine, or Sasang constitution between single infarction and multiple infarction. However, there were more significant associations with patients' smoking and stress with multiple infarctions than single infarction. Conclusion : From this study we could roughly grasp the characteristics of Small Vessel Occlusion patients and evaluated the characteristics of patients with multiple infarction. However, due to the special circumstance of the KOMC inpatients it is difficult to generalize our results; further multiple center research with a larger study group is needed.

• The Journal of Internal Korean Medicine
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• v.27 no.4
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• pp.905-914
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• 2006

Background and Purpose : The purpose of this study was to classify according to the TOAST classification (Trial of Org 10172 in Acute Stroke Treatment) acute stroke patients (first-ever stroke) treated at the Department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital. Methods : In the time period Oct. 2005 to Oct. 2006. 101 patients with a first-ever stroke admitted to the Department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital were included. Patients were hospitalized within 14 days after the onset of stroke. They had neurological deficits for a time more than 24 hours. We classified patients according to the original TOAST classification (Trial of Org 10172 in Acute Stroke Treatment) Results : The incidence in males was 54.4%, in females was 45.6%. Ischemic stroke (86.l%) was more common than hemorrhagic stroke (13.9%). The results of TOAST classification in this study were as follows: small-vessel occlusion, 72.4% large-artery atherosclerosis. 14.9 % cardioembolism, 4.6% stroke of other determined etiology, 4.6%: stroke of undetermined etiology, 3.5%. Patients in the small-vessel occlusion subgroup in this study were the most frequent. The result of this study is that Korean stroke registry is not in accordance with western medicine. Conclusions : The TOAST classification system is the most widely accepted tool to categorize stroke subtypes in western medicine, but in oriental medicine, it is not yet widely accepted. The authors suggest the general use of the TOAST classification to determine adequate management for stroke patients, to predict the prognosis and recurrence of stroke and to develop a Korean standard of stroke in oriental medicine.

• The Journal of Internal Korean Medicine
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• v.30 no.4
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• pp.761-771
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• 2009

Objectives : The aim of this study was to assess the relationship between metabolic syndrome and erythrocyte deform ability in acute stroke patients. Methods : Among 88 of the recruited patients, 52 were diagnosed as metabolic syndrome. We assessed their general characteristics, risk factors. We compared the assessed variables between metabolic syndrome and control group. We analyzed the relationship between metabolic syndrome and erythrocyte deform ability. We analyzed relationship between cardiovascular risk factors and erythrocyte deformability. Results : The general characteristics waist and hip circumference, waist/hip ratio were higher in metabolic syndrome group. The metabolic syndrome group was also diagnosed with hypertension, DM, and hyperlipidemia more often than the control group. The blood test metabolic syndrome group showed higher triglycerides, total lipids, fasting blood sugar, and 2 hours postprandial plasma glucose level and lower HDL-cholesterol than the control group. There were more patients diagnosed with Dampness-Phlegm in the metabolic syndrome group. There were more patients showing lower erythrocyte deform ability in the metabolic syndrome group. The plasma homocysteine level was negatively correlated with erythrocyte deform ability. Conclusion : The results reconfirmed that the risk factors are more in metabolic syndrome group. The results indicated that metabolic syndrome lead to a lower erythrocyte deform ability in small vessel disease stroke patients. The Plasma homocysteine level was negatively correlated with erythrocyte deform ability.

• Journal of Veterinary Clinics
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• v.24 no.3
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• pp.426-431
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• 2007

A 5-month-old female Samoyed dog was presented with primary complaints including exercise tolerance and neurological sign associated with hepatic encephalopathy. The major findings in clinical examination included an intermittent seizure, anemia, elevated pre- and post-prandial serum bile acid, hypoproteinemia and bilirubinuria. Diagnostic imaging studies revealed an intrahepatic portosystemic shunt (IPSS). The shunted vessel was successfully occluded by transvenous coil embolization. Clinical signs were gradually improved after shunt occlusion. This case is a rare case of IPSS in a large breed dog fixed by transvenous coil embolization.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.454-457
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• 2006

Purpose: The anastomosis of hepatic artery to recipient vessel has a major role in a liver transplantation, so its occlusion is the most important cause of failure of liver transplantations. We made the study to reveal the peculiarities in pediatric liver transplantations compared with adult cases. Methods: From January 1999 to September 2005, we performed 99 cases of pediatric liver transplantation. The mean age at operation was 4.17 years of age. The hepatic vein and portal vein are anastomosed by the general surgeons and then the hepatic artery is anastomosed by the plastic surgeons. The Doppler ultrasonography and computed tomography were used for postoperative checkup for hepatic artery patency. Results: There were no immediate complications, but hepatic arterial occlusion was developed in 3 cases (2.8%). In pediatric patients, the anastomosis of hepatic artery is more difficult than adults because of the rapid respiratory and pulse rate, the small vascular diameter, and the large gap of diameter difference between the recipient and the donor vessels. Conclusion: We could confirm that pediatric liver transplantations are relatively safe but long learning curve was needed.