• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.467-473
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• 2018

Objective : The aim of this study was to determine outcome of ischemic stroke patients in the anterior circulation treated with endovascular treatment (EVT) with intravenous thrombolysis (IVT) versus EVT alone group. Methods : A systemic literature review was performed using online database from January 2004 to January 2017. Primary outcomes were successful recanalization seen on finial angiography and good outcome at three months. Secondary outcomes were mortality and the development of symptomatic intracranial hemorrhage (S-ICH) after the procedure. A fixed effect model was used when heterogeneity was less than 50%. Egger's regression test was used to assess publication bias. Results : Five studies were included for final analysis. Between EVT with IVT and EVT alone group, successful recanalization (odds ratio [OR] 1.467, p=0.216), good clinical outcome at three months (OR 1.199, p=0.385), mortality (OR 0.776, p=0.371), and S-ICH (OR 1.820, p=0.280) did not differ significantly. Egger's regression intercept with 95% confidence interval (CI) was 1.99 (95% CI -2.91 to 6.89) in successful recanalization and -0.27 (95% CI -6.35 to 5.80) in good clinical outcome, respectively. Conclusion : The two treatment modalities, EVT with IVT and EVT alone, could be comparable in treating acute anterior circulation stroke. Studies to find specific beneficiary group for EVT alone, without primary IVT, are needed further.

• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.419-425
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• 2015

Objective : Acute vertebrobasilar artery occlusion (AVBAO) is a devastating disease with a high mortality rate. One of the most important factors affecting favorable clinical outcome is early recanalization. Mechanical thrombectomy is an emerging treatment strategy for achieving a high recanalization rates. However, thrombectomy alone can be insufficient to complete recanalization, especially for acute stroke involving large artery atheromatous disease. The purpose of this study is to investigate the safety and efficacy of mechanical thrombectomy in AVBAO. Methods : Fourteen consecutive patients with AVBAO were treated with mechanical thrombectomy. Additional multimodal treatments were intra-arterial (IA) thrombolysis, balloon angioplasty, or permanent stent placement. Recanalization by thrombectomy alone and multimodal treatments were assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcome was determined using the National Institutes of Health Stroke Scale (NIHSS) at 7 days and the modified Rankin Scale (mRS) at 3 months. Results : Thrombectomy alone and multimodal treatments were performed in 10 patients (71.4%) and 4 patients (28.6%), respectively. Successful recanalization (TICI 2b-3) was achieved in 11 (78.6%). Among these 11 patients, 3 (27.3%) underwent multimodal treatment due to underlying atherosclerotic stenosis. Ten (71.4%) of the 14 showed NIHSS score improvement of >10. Overall mortality was 3 (21.4%) of 14. Conclusion : We suggest that mechanical thrombectomy is safe and effective for improving recanalization rates in AVBAO, with low complication rates. Also, in carefully selected patients after the failure of recanalization by thrombectomy alone, additional multimodal treatment such as IA thrombolysis, balloons, or stents can be needed to achieve successful recanalization.

• Journal of Korean Neurosurgical Society
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• 제38권4호
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• pp.281-286
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• 2005

Objective : The authors report our experience of urokinase thrombolysis in treating patients harboring nonaneurysmal spontanesous intraventricular hemorrhage[IVH] and evaluated complications, safety and feasibility of this procedure retrospectively. Methods : Fifty-three patients with nonaneurysmal IVH>15mL without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale[GCS]<5 were excluded. A catheter was directed into the IVH. Hematoma aspiration was followed by instillation of urokinase at the ear level of drainage bag under intracranial pressure monitoring system. This was repeated every 6hours until half of its initial volume. For analysis of prognostic factors, we classified the patients into two groups by Glasgow outcome scale[GOS]; good [$GOS\;{\ge}3$] and bad [GOS<3] prognosis group, and performed comparative analysis between two groups. Results : Mean age was 60.2years. The baseline hematoma size ranged 16 to 72mL. IVH volume reduction was done by an average of 74.2%. As complications, there were 3cases of rebleeding and 2cases of ventriculitis. No intracranial adverse effects were observed during thrombolytic theraphy. At 6months after the procedure, 29patients had achieved a good recovery, 15remained vegetative. 9patients died in hospital. The main good prognostic factors were young age, small IVH volume, and high GCS. Conclusion : The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.

• Journal of Chest Surgery
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• 제34권9호
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• pp.711-715
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• 2001

배경: 심부정맥 혈전증인 증세발현 초기에 적절히 치료하면 완치될 수 있는 질환이다. 만성 심부정맥 혈전증을 장기 추적해 보면 그 결과가 정맥판막 폐쇄부전증, 정맥성 파행, 울혈성 궤양 및 하지 부종 등의 심각한 합병증을 유발한다는 것을 알 수 있다. 혈전 용해술은 용해제를 직접 원하는 혈전 부위에 주입하는 적극적인 치료방법이다. 이 연구의 목적은 유로키나제를 카테터를 통하여 주입하는 방법으로 급성 심부정맥 혈전증을 치료하여 그 효과를 확인하고자 하였다. 대상 및 방법: 급성 심부정맥 혈전증으로 진단받고, 선택적 혈전 용해술에 금기 사항에 없는 5명의 환자를 대상으로 하였다. 결과: 임상적으로 대부분의 혈전을 녹이는데 성공하였다. 총 혈전용해제 투여시간을 평균 2.0$\pm$0.6일 이었고, 유로키나제 사용량은 평균 590만$\pm$245만 IU였다. May-Therner 증후군으로 진단한 4명의 환자에게 총 5개의 스텐트를 삽입하였다. 시술 후 혈뇨가 2예, 천자부위의 혈종이 1예 등이 있었으나 모두 자연 소실되었다. 결론: 급성 심부정맥 혈전증에서 카테터를 이용한 혈전 용해술은 매우 유용한 치료방법이다.

• 한국정밀공학회지
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• 제26권7호
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• pp.22-30
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• 2009

• 한국소음진동공학회:학술대회논문집
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• 한국소음진동공학회 2010년도 춘계학술대회 논문집
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• pp.401-402
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• 2010

• 대한신경과학회지
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• 제36권4호
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• pp.408-410
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• 2018

• Journal of Yeungnam Medical Science
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• 제31권1호
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• pp.28-32
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• 2014

Pulmonary thromboembolism (PTE) increases the pressure of the right ventricle and leads to symptoms and signs, such as dyspnea and hypoxia. If PTE causes hemodynamic instability, thrombolytic therapy should be considered. A mechanical thrombectomy is an alternative treatment to thrombolytic therapy and should be considered when thrombolytic therapy is contraindicated. Various devices are used in mechanical maceration and catheter-directed thrombolysis, but there is no standard mechanical device for PTE as yet. We report here on 2 clinical experiences of mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombolytic device to remove residual clots after systemic thrombolysis in patients with massive PTE.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2007년도 Techno-Fair 및 추계학술대회 논문집 전기물성,응용부문
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• pp.152-153
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• 2007

This paper describes a resonant driving piezoelectric micro cantilever practicable to ultrasound thrombolysis device for the treatment of ischemic stroke. The proposed piezoelectric cantilever was designed to be a unimorph structure of Si/$SiO_2$/Ti/Pt/PZT/Pt, and fabricated by top-down sequence etching process. The red blood cell (RBC) lysis experiment was carried out to confirm the usability of the proposed cantilever. Total 87.76 % of RBCs were ruptured using the ultrasound generated by up-down actuations of the fabricated cantilever with AC voltage having the frequency of 19.36 Hz and the magnitude of $30V_{p-p}$.

• Tuberculosis and Respiratory Diseases
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• 제40권2호
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• pp.123-134
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• 1993

연구배경 : 조직형플라스미노겐활성체는 생리적인 플라스미노겐활성체이므로 혈전의 섬유소에 결합된 플라스미노겐만을 활성화시키는 특이성이 있어 효과적이고 안전한 혈전용해제로 사용될 수 있다고 기대된다. 그러나 조직형플라스미노겐활성체의 투여방법에 대해서는 장시간동안 계속 주입해야한다는 주장과 투여시간을 1시간이내로 해도 혈전용해효과는 지속적으로 나타나고 부작용을 유발하는 정도도 미미하므로 투여시간을 짧게 하자는 주장이 양립하고 있는 실정이다. 본 연구에서는 폐혈전색전증에서 조직형플라스미노겐활성체의 투여방법에 따라 혈전용해효과가 어떻게 달라지고 폐색전증으로 인한 심폐기능장애가 약제의 투여방법에 따라 어떠한 영향을 받는지를 알아보고자 하였다. 방법 : 실험견에 방사성동위원소로 표지된 자가혈병으로 대량의 폐색전종을 유발시켜서 대조군은 특이치료를 하지 않고 제 1 치료군은 15분동안, 제 2 치료군은 3시간에 걸쳐서 재조합형의 조직형플라스미노겐활성체를 체중당 1mg씩 정맥주입하였다. 그리고 실험과정중 4시간동안 혈전색전에서 방출되는 감마선량과 각종 혈역학적 지표를 감시하고 주기적으로 동맥혈 및 혼합정맥혈의 가스분석을 시행하여 어떠한 약제투여방법이 더 효율적인가를 분석하였다. 결과: 1) 혈전용해효과는 제 1 치료군이 $36.2{\pm}3.3%$, 제 2 치료군이 $39.6{\pm}2.3%$로 유의한 차이가 없었으며, 혈전용해속도는 제 1 치료군이 $81.4{\pm}16.8%/hr$, 제 2 치료군이 $37.3{\pm}2.4%/hr$로 제 1 치료군에서 급속한 혈전용해효과를 보였다 (p<0.05). 2) 약제의 작용시간은 제 1 치료군이 $63.3{\pm}22.2$분, 제 2 치료군이 $148.5{\pm}14.0$분으로 (p<0.05), 제 1 치료군에서는 약제투여후에도 지속적인 혈전용해효과를 보이지만 제 2 치료군에서는 약제투여중에 혈전용해효과가 정지되었다. 3) 폐색전증으로 인한 혈역학적 장애와 가스교환의 장애는 제 1 치료군 및 제 2 치료군에서 비슷한 정도로 개선되었으나, 제 1 치료군에서 보다 신속하게 개선되었다(p<0.05). 결론 : 폐색전증에서 치료목적으로 동량의 조직형플라스미노겐활성체를 투여할때 약제의 투여시간이 15분인 경우와 180분인 경우를 비교해보면, 혈전색전의 용해정도는 비슷하지만 혈전의 용해속도 및 폐색전증으로 인한 심폐기능장애의 개선효과는 약제의 투여시간이 15분일 때 더 우수하였다. 따라서 약제의 투여시간을 짧게하여 혈전의 용해속도를 촉진함으로써 폐색전증으로 인한 심폐기능장애를 신속히 개선할 수 있겠다.