• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.1
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• pp.23-29
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• 2024

Objective: Flow diverting stents (FDS) are increasingly used for the treatment of intracranial aneurysms. While FDS can provide flow diversion of parent vessels, their high metal surface coverage can cause thromboembolism. Transcranial Doppler (TCD) emboli monitoring can be used to identify subclinical embolic phenomena after neurovascular procedures. Limited data exists regarding the use of TCDs for emboli monitoring in the periprocedural period after FDS placement. We evaluated the rate of positive TCDs microembolic signals and stroke after FDS deployment at our institution. Methods: We retrospectively evaluated 105 patients who underwent FDS treatment between 2012 and 2016 using the Pipeline stent (Medtronic, Minneapolis, MN, USA). Patients were pretreated with aspirin and clopidogrel. All patients were therapeutic on clopidogrel pre-operatively. TCD emboli monitoring was performed immediately after the procedure. Microembolic signals (mES) were classified as "positive" (<15 mES/hour) and "strongly positive" (>15 mES/hour). Clinical stroke rates were determined at 2-week and 6-month post-operatively. Results: A total of 132 intracranial aneurysms were treated in 105 patients. TCD emboli monitoring was "positive" in 11.4% (n=12) post-operatively and "strongly positive" in 4.8% (n=5). These positive cases were treated with heparin drips or modification of the antiplatelet regimen, and TCDs were repeated. Following medical management modifications, normalization of mES was achieved in 92% of cases. The overall stroke rates at 2-week and 6-months were 3.8% and 4.8%, respectively. Conclusions: TCD emboli monitoring may help early in the identification of thromboembolic events after flow diversion stenting. This allows for modification of medical therapy and, potentially, preventionf of escalation into post-operative strokes.

• Journal of Korean Neurosurgical Society
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• v.67 no.5
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• pp.531-540
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• 2024

Objective : The use of reconstructive treatment with a double-overlapping stents has proven to be effective and safe in the current treatment of intracranial vertebral artery dissecting aneurysms (VADAs). We employed a combination of overlapping stents, using low-profile visualized intraluminal support (LVIS) within the Enterprise stent. This combination was chosen to minimize the outward bulging of the inner LVIS by overlapping it with the Enterprise stent while maintaining flow diversion and stability. This study aimed to evaluate the clinical and angiographic outcomes following the use of double-overlapping stents with LVIS within the Enterprise stent for the treatment of VADAs. Methods : From March 2016 to January 2022, total 28 patients with unruptured VADAs were treated with the double-overlapping stent technique using LVIS within an Enterprise stent in our institute. The Enterprise stent was deployed first, followed by the LVIS stent. Patient clinical and angiographic characteristics, procedural complications, and follow-up outcomes were retrospectively reviewed. Results : All 28 patients (18 males and 10 females) were successfully treated with double-overlapping stent deployment. There were no procedural complications or new neurological deficits in any patient. Of the 28 patients, four VADAs had posterior inferior cerebellar artery involvement. Procedure-related parent artery occlusion did not occur during the angiographic follow-up conducted 6 to 12 months after the procedure. Out of 28 patients, 24 showed complete healing, three had focal residual stenosis or dilatation with residual sac and only one had a residual dissecting flap with aneurysm. All patients, including the four patients, did not require any additional procedures. The postoperative modified Rankin scale scores were 0-1 for all patients. Conclusion : A double-overlapping stent, with a flow-diversion effect, is a safe and effective treatment for patients with VADAs. In particular, when using the LVIS stent within an Enterprise stent, it minimizes the bulging of the inner LVIS stent while maintaining flow diversion and stability. Therefore, both can be effectively utilized as overlapping stents.

• Journal of Korean Neurosurgical Society
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• v.67 no.5
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• pp.541-549
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• 2024

Objective : Advancements in AVM surgical techniques for cerebral arteriovenous malformation (AVM) underscore its efficacy. Our research aims to showcase the positive outcomes of treating low-grade AVMs surgically, focusing on safety and effectiveness. Methods : We retrospectively reviewed 55 patients (36 males and 19 females; average age 37.4 years) with Spetzler-Martin (S-M) grade 1 and 2 AVMs who underwent surgical resection between January 2009 and December 2022. Results : In our study, 55 patients with S-M grade 1 and 2 AVMs underwent surgical resection, evenly divided between grades 1 (50.9%) and 2 (49.1%). Intracranial hemorrhage was the primary symptom in 74.5% of cases. Pre-operative Glasgow coma scale (GCS) scores revealed 69.1% of patients scored above 13, with 18% below 8. Successful resection was achieved in 87.3%. Postoperatively, 95.5% of ruptured and 90.9% of unruptured AVM patients showed lower or same modified Rankin scale scores. Poorer outcomes were significantly linked to lower GCS scores and intranidal/flow-related aneurysms through multivariate logistic regression. Postoperative seizures noted in nine patients, were exclusive to the ruptured AVM group. Conclusion : Our findings indicate surgical resection as a beneficial treatment for low-grade AVMs, yielding high cure rates and positive functional outcomes in both ruptured and unruptured cases. Preoperative GCS scores and the presence of associated aneurysms are predictive of postoperative functional status. Additionally, managing postoperative seizures effectively is key to enhancing prognosis.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.983-988
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• 1996

Aneurysm of the sinus of Valsalva is fairly rare. Between 1987 and 1994, we operated on a total of 12 cases of aneurysm of the sinus of Valsalva at the Inje University Seoul Paik Hospital. This represents 0.7% of all cardiac operation under cardiopulmonary bypass. There were eight male and four female patients aged from 8 to 38 years(mean, 19.2 years). 8 of 12 patients had ruptured aneurysms. The origin of aneurysm of the sinus of Valsalva was the right coronary sinus in 10(83. 3%), and the noncoronary sinus in 2(16.6%). In ruptured aneurysm, the origin was the right oronary sinus in 6, and the noncoronary sinus in 2. The aneurysms originating from the right coronary sinus ruptured into the right ventricle in 5, and into both the right atrium and right ventricle in 1. The aneurysms originating from the noncoronary sinus ruptured into the right ventricle in 1, and into the right atrium in 1. Associated congenital cardiac defects included ventricular septal defect in 10(83.3%) patients 39 cases of these were associated with the aneurysms of the right coronary sinus), aortic regurgi- tation in 3 (all of these had an additional ventricular septal defect), mitral regurgitation in 1, and double chambered right ventricle in 1. No hospital deaths occurred, although one late death occurred as a result of endocarditis 15 months after the first operation. The mean follow-up period was 29 months, range from 4 to 60 months. Eleven patients except one late death were in New York Heart Association class 1. Due to the low mortality risk o( an operation for aneur sm of the sinus of Valsalva, a ruptured aneurysm of the sinus of Valsalva should be corrected surgically when the diagnosis is mane, and unruptured aneurysm of the sinus of Valsava with complication should also be operated. In most cases the aorta was opened to examine the morphology of the aneurysm and the aortic cusps, and an associated aortic valve defect should be corrected simultaneously.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.413-415
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• 2014

The superficial femoral artery (SFA) is a relatively rare location for lower limb aneurysmatic disease. In the literature, this disease is described an association between a relatively high growth rate and/or the rupture of aneurysms and chemotherapeutic agents. We report a case of the rupture of a giant SFA aneurysm in a patient during chemotherapy for acute lymphatic leukemia.

• The Korean Journal of Pain
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• v.27 no.4
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• pp.360-364
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• 2014

The causes of sciatica are variable and include musculoskeletal, dermatologic, infectious, neoplastic, and vascular disorders. In many cases, the symptom is usually caused by degenerative disease in the spine with the compression or irritation of spinal nerve. On the other hands, there are also several announced extra-spinal causes including aneurysm, diabetes, and radiation for sciatica in a low rate. Among the extra-spinal cases, aneurysms arising from iliac vessels are sometimes developing a diagnostic confusion with the spinal causes, and delayed diagnosis can lead to poor prognosis. It is very important to pay attention weather the aneurysmal cause is involved in the symptom of sciatica.

• Journal of Chest Surgery
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• v.24 no.11
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• pp.1144-1148
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• 1991

Ventricular false aneurysm is a rare complication of myocardial infarction We successfully operated on a case of left ventricular false aneurysm complicating a silent, undiagnosed myocardial infarction The patients, 64 year-old female, showed marked improvement in her congestive symptom after the operation and was discharged without any complication With its peculiar feature, i.e., propensity to rupture, in addition to the functionally harmful aspects shared with the true aneurysms, a false aneurysm must always be considered to be a surgical indication. Good results can be achieved by proper diagnosis and management with low operative risk.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.202-205
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• 1991

Development of an aneurysm in the thoracic aorta, intercostal arteries, or cerebral vessels is not an uncommon occurrence in patients with coarctation of the aorta. The mechanism whereby coarctation predisposes to aneurysm formation is incompletely understood and we suggest that in this case, an intrinsic factor in the wall of the aorta underlies the formation of aneurysms. Recently we experienced one case of COA associated with the thoracic aortic aneurysm and operation was done successfully. PDA was simply ligated and the aorta was cross-clamped proximally and distally and the area of constriction or aneurysmal site were excised. Postoperative course was uneventful and the patient was discharged 2 weeks after operation. Hypertension at upper extremities was controlled without any antihypertensive drugs after operation and the degree of regurgitation of mitral valve was improved postoperatively but long-term follow-up should be necessary.

• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.193-195
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• 2007

Middle cerebral artery [MCA] aneurysms are a common source of subarachnoid hemorrhage [SAH]. But, ruptured distal MCA aneurysm is very rare, and their clinical and radiological features are poorly understood. Microsurgical repair remains the most common method used to treat distal MCA aneurysm, even though endovascular coiling has been favored recently. We report our experience of successful coiling for ruptured distal MCA aneurysm, In selected patients, coiling may be a good treatment option for ruptured distal MCA aneurysm.

• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.196-199
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• 2007

Dissecting aneurysms frequently involve the vertebral arteries and their branches, but those involving the posterior inferior cerebellar artery [PICA] and not vertebral artery at all are extremely rare. We present a case of an isolated dissecting aneurysm of the PICA without involvement of vertebral artery. A 54-year-old man presented with dizziness and headache. MR imaging of the brain showed a cerebellar infarction of the left PICA territory. MR angiographic and cerebral angiographic studies revealed a dissecting fusiform aneurysm involving the left proximal PICA. Subsequently, the patient underwent GDC embolization. A postembolization angiogram demonstrated complete obliteration of the aneurysm. In this report, the treatment modalities for this rare condition is described with review of the literature.