• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.81-85
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• 2013

Objective : Transfemoral catheter angiography (TFCA) is a basic procedure in neurovascular surgery with increasing importance in surgical and non-invasive treatments. Unfortunately, resident neurosurgeons have relatively few opportunities to perform TFCA in most institutions. We report a method developed in our hospital for training resident neurosurgeons to perform TFCA and evaluate the efficacy of this training. Methods : From May 2011 to September 2011, a total of 112 consecutive patients underwent TFCA by one resident neurosurgeon supervised by two neuroendovascular specialists. Patients who underwent elective diagnostic procedures were included in this study. Patients who underwent endovascular treatment were excluded. Demographic data, indications for TFCA, side of approach, number of selected arteries, and complications were analyzed. Results : This study included 64 males and 48 females with a mean age of 51.6 (12-81) years. All procedures were performed in the angiography suite. Common indications for procedures were as follows : stroke-induced symptoms in 61 patients (54.5%), Moyamoya disease and arteriovenous malformation in 13 patients (11.6%), and unruptured intracranial aneurysm in eight patients (7.1%). Right and left femoral puncture was performed in 98.2% and 1.8% of patients, respectively. A total of 465 selective angiographies were performed without complications. Angiographic examination was performed on 4.15 vessels per patient. Conclusion : TFCA can be performed safely by resident neurosurgeons based on anatomical study and a meticulous protocol under the careful supervision of neuroendovascular specialists.

• 대한영상의학회지
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• 제82권5호
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• pp.1258-1273
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• 2021

목적 풍선-스텐트 테크닉(balloon-stent technique; 이하 BST)은 복잡한 동맥류를 치료하는 보조술로서 그 고유한 장점을 가지고 있다. 저자들의 기관에서 Atlas의 출시 이래 Scepter-Atlas 조합의 BST를 치료에 적용해 온 경험을 공유하고자 한다. 대상과 방법 초기에 Atlas를 Scepter 카테터에 진입시키지 못하는 기술적 실패를 겪은 뒤 이를 해결하기 위해 문제가 되었던 기구들을 면밀히 관찰하였다. 2018년 3월부터 2019년 12월까지 총 57개의 비파열성 원위내경동맥 동맥류에 대해 코일 색전술을 시행하였고, 이중 25개(23명)의 증례는 BST로 치료하였다. 포함된 증례들의 영상 및 임상 정보는 후향적으로 수집하고 분석하였다. 결과 이 논문에서 소개하는 간단한 팁을 알게 된 이후 Scepter-Atlas 조합의 기술적 성공률은 50%에서 100%로 상승하였다. BST로 치료한 환자군에서 시술 직후에 84%, 추적검사에서 95.8%가 완전하거나 거의 완전한 폐색을 보였고 stent-assisted coil 그룹에서는 각각 96.3%, 88.4%가 시술 직후와 추적검사에서 같은 결과를 보였다. 소수의 환자에서 합병증을 보였지만 임상적으로 문제가 된 증례는 없었다. 결론 Scepter-Atlas 조합을 이용한 BST는 원위내경동맥에 위치한 비파열성 동맥류를 치료하는 데 효과적이고 안전한 방법이 될 수 있다. Scepter는 Atlas를 매개하는 카테터로 충분히 사용될 수 있다.

• Journal of Korean Neurosurgical Society
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• 제60권4호
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• pp.424-432
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• 2017

Objective : Small unruptured aneurysms (<5 mm) are known for their very low risk of rupture, and are recommended to be treated conservatively. However, we encounter many patients with small ruptured aneurysms in the clinical practice. We aimed to investigate the incidence and characteristics of patients with small ruptured aneurysms. Methods : We reviewed all patients admitted to our hospital with subarachnoid hemorrhage from January 2005 to December 2015. The patients were divided into two groups : those with aneurysms <5 mm (group S) and those with aneurysms ${\geq}5mm$ (group L). The patient's age and sex, size and location of aneurysms, and risk factors such as hypertension, diabetes, alcohol use, and smoking were compared between the two groups. Results : Eight-hundred eleven patients were diagnosed with ruptured aneurysms, and 337 (41.6%) were included in group S. The mean size of all aneurysms was $6.10{\pm}2.99mm$ (range, 0.7-37.7); aneurysms with a diameter of 4-5 mm accounted for the largest subgroup of all aneurysms. Female sex was significantly associated with the incidence of small ruptured aneurysms (odds ratio [OR] 1.50, 95% confidence intervals [CI] 1.02-2.19, p=0.037). Despite female predominance in the incidence of small ruptured aneurysms, the proportion of small ruptured aneurysms in young (<50 years) men was high. In men, there were no significant differences regarding the location of the aneurysms between group S and group L (p=0.267), with the most frequent location being the anterior communicating artery (ACoA) in both group S (50.9%) and group L (51.4%). However, in women, there were significant differences regarding the location of the aneurysms between group S and group L (p=0.023), with the most frequent locations being the ACoA (33.0%) in group S, and the posterior communicating artery (30.6%) in group L. In women, two locations were significantly associated with small (<5 mm) ruptured aneurysms: the ACoA (OR 2.14, 95% CI 1.01-4.54, p=0.047) and anterior cerebral artery (OR 3.54, 95% CI 1.19-10.54, p=0.023). Multiplicity and smoking were significantly associated with large (${\geq}5mm$) ruptured aneurysms in women. The use of alcohol was related to small ruptured aneurysms in men over 50 years of age (OR 2.23, 95% CI 1.03-4.84, p=0.042). Conclusion : In this study, small (<5 mm) ruptured aneurysms exhibited different incidences by age, sex, location, and risk factors such as multiplicity, smoking, and alcohol use.

• Korean Journal of Radiology
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• 제25권6호
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• pp.575-588
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• 2024

Objective: Differentiating intracranial aneurysms from normal variants using CT angiography (CTA) or MR angiography (MRA) poses significant challenges. This study aimed to evaluate the efficacy of proton-density MRA (PD-MRA) compared to high-resolution time-of-flight MRA (HR-MRA) in diagnosing aneurysms among patients with indeterminate findings on conventional CTA or MRA. Materials and Methods: In this retrospective analysis, we included patients who underwent both PD-MRA and HR-MRA from August 2020 to July 2022 to assess lesions deemed indeterminate on prior conventional CTA or MRA examinations. Three experienced neuroradiologists independently reviewed the lesions using HR-MRA and PD-MRA with reconstructed voxel sizes of 0.25³ mm³ or 0.2³ mm³, respectively. A neurointerventionist established the gold standard with digital subtraction angiography. We compared the performance of HR-MRA, PD-MRA (0.25³-mm³ voxel), and PD-MRA (0.2³-mm³ voxel) in diagnosing aneurysms, both per lesion and per patient. The Fleiss kappa statistic was used to calculate inter-reader agreement. Results: The study involved 109 patients (average age 57.4 ± 11.0 years; male:female ratio, 11:98) with 141 indeterminate lesions. Of these, 78 lesions (55.3%) in 69 patients were confirmed as aneurysms by the reference standard. PD-MRA (0.25³-mm³ voxel) exhibited significantly higher per-lesion diagnostic performance compared to HR-MRA across all three readers: sensitivity ranged from 87.2%-91.0% versus 66.7%-70.5%; specificity from 93.7%-96.8% versus 58.7%-68.3%; and accuracy from 90.8%-92.9% versus 63.8%-69.5% (P ≤ 0.003). Furthermore, PD-MRA (0.25³-mm³ voxel) demonstrated significantly superior per-patient specificity and accuracy compared to HR-MRA across all evaluators (P ≤ 0.013). The diagnostic accuracy of PD-MRA (0.2³-mm³ voxel) surpassed that of HR-MRA and was comparable to PD-MRA (0.25³-mm³ voxel). The kappa values for inter-reader agreements were significantly higher in PD-MRA (0.820-0.938) than in HR-MRA (0.447-0.510). Conclusion: PD-MRA outperformed HR-MRA in diagnostic accuracy and demonstrated almost perfect inter-reader consistency in identifying intracranial aneurysms among patients with lesions initially indeterminate on CTA or MRA.