• Korean Journal of Radiology
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• 제1권2호
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• pp.65-72
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• 2000

Objective: To compare the efficacy of suprapapillary and transpapillary methods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied. Materials and Methods: Stents were placed in 59 patients. Strictures were categorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared. Results: Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapapillary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p = 0.37) or method (p = 0.62). Conclusion: For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed.

• Journal of Digestive Cancer Research
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• 제9권2호
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• pp.43-49
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• 2021

Background/Aims: Colonic stenting as a bridge to elective surgery is an alternative for emergency surgery in patients with acute malignant colonic obstruction. However, since its benefits are uncertain, we aimed to establish whether it has better clinical outcomes. Methods: The patients with acute malignant left-sided colon obstruction enrolled from January 2009 to December 2018 in National Health Insurance Service Ilsan Hospital. The patients were enrolled to undergo colonic stenting as a bridge to elective surgery or emergency surgery. The following oncological outcomes were assessed: incidence of complete remission, disease progression, local recurrence, and systemic recurrence. Results: Out of 40 patients, 33 received self-expanding metallic stent (SEMS) as a bridge-to-surgery, and 7 underwent emergency surgery. More stoma was made in case of emergency surgery with statistical significance (p < 0.001). There were no significant differences in complete remission rate in curable left-sided malignant colonic obstruction between SEMS as a bridge-to-surgery and emergency surgery. Complete remission was achieved for 3 patients (42.9%) in the non-stent group and 27 patients (81.8%) in the stent group. There was no statistically significant difference in oncologic outcomes between the two groups (p = 0.069). According to multi-variate analysis, advanced TNM stage, Adjuvant chemotherapy, and SEMS bridge-to-surgery were significantly associated with disease-free survival. Disease-free survival rate differed significantly between the two groups (p = 0.024). Conclusions: SEMS as a bridge-to-surgery might be an effective strategy and reduce stoma formation in acute malignant left-sided colon obstruction.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권4호
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• pp.420-428
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• 2023

Objective: Intraprocedural rupture (IPR) is a fatal complication of endovascular coiling for cerebral aneurysms. We hypothesized that contrast leakage period may be related to poor clinical outcomes. This study aimed to retrospectively evaluate the relationship between clinical outcomes and contrast leakage period. Methods: Data from patients with cerebral aneurysms treated via endovascular coiling between January 2010 and October 2018 were retrospectively assessed. The enrolled patient's demographic data, the aneurysm related findings, endovascular treatment and IPR related findings, rescue treatment, and clinical outcome were analyzed. Results: In total, 2,859 cerebral aneurysms were treated using endovascular coiling during the study period, with IPR occurring in 18 (0.63 %). IPR occurred during initial frame coiling (n=4), coil packing (n=5), stent deployment (n=7), ballooning (n=1), and microcatheter removal after coiling (n=1). Tear sites included the dome (n=14) and neck (n=4). All IPRs were controlled and treated with coil packing, with or without stenting. Flow arrest of the proximal balloon was not observed. Temporary focal neurological deficits developed in two patients (11.1%). At clinical follow-up, 14 patients were classified as modified Rankin Scale (mRS) 0, three as mRS 2, and one as mRS 4. The mean contrast leakage period of IPR was 11.2 min (range: 1-31 min). Cerebral aneurysms with IPR were divided into late (n=9, mean time: 17.11 min) and early (n=9, mean time: 5.22 min) control groups based on the criteria of 10 min of contrast leakage period. No significant between-group differences regarding clinical outcomes were observed after IPR (p=1). Conclusions: In our series, all patients with IPR were controlled with further coil packing or stenting without proximal balloon occlusion within 31 min of contrast leakage. There was no difference in clinical outcomes when the long contrast leakage period group and short contrast leakage period group were compared.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권2호
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• pp.160-174
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• 2023

Objective: Carotid artery stenting (CAS) is currently widely used for the treatment of carotid artery stenosis. The objective of this study was to analyze the outcomes of CAS performed in a single institution. Methods: We retrospectively analyzed 313 CAS cases from January 2007 to December 2020, including 206 (66%) symptomatic and 107 (34%) asymptomatic cases. Procedure-related morbidity and mortality were assessed. Rates of periprocedural (≤30 days after CAS) and postprocedural ipsilateral strokes (>30 days after CAS) were also assessed. Logistic regression analysis was used to identify risk factors for the periprocedural complication, in-stent restenosis (ISR), and ipsilateral stroke. Results: The success rate of CAS was 98%. Among 313 cases, 1 patient died due to hyperperfusion-related intracerebral hemorrhage (ICH). The CAS-related mortality rate was 0.31%. The overall incidence of periprocedural complications is 5.1%. A risk factor for periprocedural complication was a symptomatic carotid artery stenosis (7.3% vs. 0.9%, p=0.016). Twenty cases of ISR occurred during 63.7±42.1 months of follow-up. The overall incidence of ISR was 10.2% (20/196). A risk factors for ISR were diabetes mellitus (17.6% vs. 5.7%, p=0.008) and patients who used Open-cell stents (19.6% vs. 6.9%, p=0.010). The overall incidence of ipsilateral stroke is 5.6%. A risk factors for ipsilateral stroke was ISR (95% CI, p=0.002). Conclusions: CAS is a safe and effective procedure for carotid artery stenosis. Although the incidence of complications is low, fatal complication such as hyperperfusion-related ICH can occur. To prevent hyperperfusion-related ICH, several methods such as strict blood pressure (BP) control, intentional less widening of stenotic segment should be used. To prevent ISR or stroke occurrence, special attention should be paid to patients who have ISR or ipsilateral stroke risk factors.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제26권2호
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• pp.130-140
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• 2024

Objective: To assess whether local anesthetic infiltration could minimize the carotid baroreceptor reflex (CBR) which has an incidence after carotid artery stenting (CAS) that varies from 29% to 51%. Methods: This retrospective single-center study included 51 patients (mean age, 70.47 years) who underwent CAS for carotid stenosis. The groups included patients who underwent CAS for asymptomatic ischemic stroke (n=41) or symptomatic disease (n=10). Preprocedural percutaneous lidocaine injections (PPLIs) were administered to 70.6% and 5.9% of patients who underwent elective CAS and emergency CAS, respectively. Results: Among patients who received PPLIs, the mean degree of stenosis was 80.5% (95% confidence interval [CI]: ±10.74, 51-98%). The mean distance from the common carotid artery bifurcation to the most stenotic lesion (CSD) was 8.3 mm (95% CI: ±0.97, 6.3-10.2 mm); the mean angle between the internal carotid artery and common carotid artery (CCA) trunk (IAG) was 65.6° (95% CI: ±2.39, 61-70°). Among patients who did not receive PPLIs, the mean degree of stenosis was 84.0% (95% CI: ±8.96, 70-99%). The mean CSD was 5.9 mm (95% CI: ±1.83, 1.9-9.9 mm); the mean IAG was 60.4° (95% CI: ±4.41, 51-70°). The procedure time was longer in the PPLI group than in the no PPLI group (28.19 [n=39] vs. 18.88 [n=12] days) (P=0.057); the length of intensive care unit stay was shorter in the PPLI group (20.01 [n=36] vs. 28.10 [n=5] days) (P=0.132). Conclusions: Targeted PPLI administration to the carotid bulb decreased aberrant heart rates and blood pressure changes induced by carotid stent deployment and balloon inflation. As CBR sensitivity increases with decreasing distance to the stenotic lesion from the CCA bifurcation, PPLIs may help stabilize patients during procedures for stenotic lesions closer to the CCA.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제26권2호
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• pp.163-173
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• 2024

Objective: We aimed to investigate the incidence of flow arrest during carotid artery stenting (CAS) with filter-type embolic protection device (EPD), identify any predisposing factors for those situations, and contemplate intraprocedural precautionary steps. Methods: CAS was performed in 128 patients with 132 arteries using filter-type EPD. The characteristics of treated patients and arteries were compared between groups with and without flow arrest. Results: The incidence of flow arrest during CAS with filter-type EPD was 17.4%. In flow arrest group, cases of vulnerable plaques (p=0.02) and symptomatic lesions (p=0.01) were significantly more common, and there were more cases of debris captured by EPD in a planar pattern (p<0.01). Vulnerable plaques were significantly more common in the procedures showing a planar pattern than in the cases with other patterns (p<0.01). Flow arrest group showed a significantly higher rate of ischemic complications (p<0.05), although there were no significant periprocedural neurological changes. The planar pattern of captured debris in filter-type EPD was the only significant risk factor for flow arrest (adjusted odds ratio 88.44, 95% confidence interval 15.21-514.45, p<0.05). Conclusions: Flow arrest during CAS with filter-type EPD is not uncommon and associated with increased ischemic complications. Symptomatic stenoses and vulnerable plaque are related to this event. The planar pattern of captured debris on the EPD was the only significant risk factor for the flow arrest. Clinicians must pay attention to the occurrence of flow arrest and react quickly when performing CAS.

• Journal of Gastric Cancer
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• 제7권2호
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• pp.82-87
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• 2007

목적: 위암에 의한 위출구 폐쇄는 다양한 소화기 증상과 영양 실조를 야기하며, 따라서 삶의 질을 떨어뜨리고 생명을 단축시킨다. 이처럼 위날문부 폐쇄 환자에게 시행하는 스텐트삽입 시술은 위 공장 우회술에 비교하여 덜 침습적이고 효과적인 시술로 알려져 있다. 그러나, 위암에서의 스텐트 시술의 효과와 위공장 우회술의 효과에 대한 비교연구는 찾아볼 수 없다. 대상 및 방법: 2000년 1월부터 2006년 8월까지 고신대학교 복음병원에서 내시경 및 위장관 조영술을 이용하여 위암으로 인한 위 날문부 폐쇄를 진단 받고, 위 날문부 스텐트 삽입시술을 받은 환자군과 위공장 우회술을 받은 환자군 간의 데이터 통계를 1개월에서 46개월까지 추적 관찰한 외래 차트를 바탕으로 후향적으로 비교하였다. 이 중 위암의 재발로 인해 시술을 받은 환자와 이중암(double cancer)으로 진단을 받은 환자는 제외하였다. 결과: 100명의 환자가 스텐트 삽입을 시행받았고, 31명의 환자가 위 공장 우회술을 시행받았다. 두 그룹 간 남녀 성별 비는 통계적인 의미가 없었으나(스텐트 M : F 2 : 1, 우회술 M : F 2 : 1, P=0.637) 연령은 스텐트군은 $67{\pm}10$, 우회술군은 $57{\pm}10$ (P<0.001)으로 통계적인 의미가 있었다. 스텐트 삽입군에서 수술을 못한 이유는 60%의 경우 암진행, 34%의 경우는 고령, 6%의 경우는 동반질환의 중중도에 의하였고, 스텐트 시술 후 가장 gms한 합병증은 스텐트내 종양성장, 다음으로 스텐트 이동이었고 시술의 실패는 3%였다. 두 군 간 시술 후 유동식까지 걸린 시간은 스텐트군 $3{\pm}2$ (일), 우회술군은 $6{\pm}2$ (일)(P=0.003) 그리고 시술 후 입원기간은 스텐트군 $5{\pm}2$ (일), 우회술군 $15{\pm}6$ (일)(P<0.001)로 모두 통계적으로 유의한 결과가 나왔다. 결론: 위암의 날문부 폐쇄 환자에게 시행한 자가팽창 금속성 스텐트 시술은 위장 우회술에 비하여 빠른 식 사진행과 짧은 입원기간으로 효과적인 시술일 수 있지만, 스텐트가 움직이거나 종양의 재성장으로 인해 스텐트를 다시 시술해야하근 불편함이 있는 등 스텐트로 인한 환자의 불편함이 많아서 향후 더욱 많은 연구가 필요할 것이다.

• Journal of Trauma and Injury
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• 제19권2호
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• pp.192-195
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• 2006

Degenerative vascular disease, previous arterial surgery, long-term ureteral stenting, pelvis surgery, and radiotheraphy are reported as causes of artery-to-collecting-system communication.. Artery-to-collecting-system- communication associated with blunt trauma is rare, but potentially fatal. The diagnosis is very difficult and requires a high degree of suspicion. We were able to make the diagnosis based on the characteristic finding of contrast-enhanced computed tomography (CT) obtained in the early phase, equivalent to the finding obtained in the corticomedullary phase of the kidney. We report a case of artery to collecting system communication due to blunt abdominal trauma following a fall, which was treated by embolization.

• Journal of Chest Surgery
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• 제53권5호
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• pp.313-316
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• 2020

Esophageal perforation after endoscopic ultrasound-guided fine-needle aspiration for mediastinal staging is a rare but severe complication. We report 2 cases of patients with esophageal perforation who were treated using video-assisted thoracoscopic surgery in combination with esophageal stenting. Through these cases, the feasibility of minimally invasive thoracic surgery was evaluated.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.43-47
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• 2020

Pancreatic and gastric fistulas are rare complications of emergency splenectomy, and it is extremely rare for a pancreatic fistula to be further complicated by a fistulation into the stomach. Here, we present a case of pancreatogastric fistula in a 60-year-old man who experienced polytrauma due to a blunt mechanism. He underwent emergency splenectomy for splenic injury and developed a pancreatic fistula as a complication. A percutaneous endoscopic procedure was performed to drain the fistula, after which he developed a pancreatogastric fistula as a further complication. A double-pigtail stent was inserted via gastroscopy into the fistula tract to allow internal drainage of the pancreatic collection into the stomach cavity. When a pancreatic fistula is complicated by gastric fistulation, endoscopic stenting of the pancreatogastric fistula tract for internal drainage is an effective treatment option.