• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.465-472
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• 2023

In predicting vascular disease, this study attempted to identify changes in the carotid intima-media thickness in patients who underwent carotid artery ultrasonography and hematological tests and to find out the effect of risk factors on the expression of atherosclerotic plaque. A retrospective analysis was conducted on 469 healthy adults who visited the hospital for the purpose of medical examination and performed carotid artery ultrasonography. As a result, carotid intima-media thickness, age, body mass index, waist circumference, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and glucose were analyzed as significant predictors of atherosclerotic plaque (p<0.001). The risk ratio was calculated based on the cut off value of the risk factors of the atherosclerotic plaque determined through ROC curve analysis, followed by 8.06 times the carotid intima-media thickness, 7.53 times the age, 3.97 times the waist circumference and 2.02 times the glucose. Therefore, in this study it was possible to prepare a Korean standard for clinical risk factors that affect the presence of absence of atherosclerotic plaque and observation of carotid artery ultrasonography is thought to help diagnose or predict cardiovascular disease early.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.2
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• pp.456-461
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• 2018

Carotid artery stenting (CAS) has emerged as an alternative treatment for carotid stenosis in patients poorly suited for endarterectomy. Intracerebral hemorrhage following carotid revascularization (endarterectomy, angioplasty, artery stenting) is rare and thought to be related to reperfusion injury in most cases. Early experience suggests an increased incidence of hemorrhage following CAS as compared to endarterectomy. In this study, data were obtained through a case report on an 80-year-old male patient with cerebral infarction. The 80-year-old hypertensive man developed sudden monoparesis in the left arm. He underwent CAS for 90% stenosis of the left proximal internal carotid artery. Brain CT after procedure showed acute hematoma with left posterior cerebral artery territorial hemorrhage, including the upper thalamus with extended intraventricular hemorrhage (IVH). Since this hemorrhage occurred in vascular territory unlikely to have been supplied by the treated artery, this case suggests that the mechanism of intracerebral hemorrhage following CAS may in some cases be different from hyperperfusion hemorrhage classically described following endarterectomy.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.178-187
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• 2020

Objective : The extensive vasa vasorum network functions as a conduit for the entry of inflammatory cells or factors that promote the progression of angiogenesis and plaque formation. Therefore, we investigated the correlation between the carotid vasa vasorum activities and carotid plaque vulnerability using indocyanine green video angiography (ICG-VA) during carotid endarterectomy (CEA). Methods : Sixty-nine patients who underwent CEA were enrolled prospectively from September 2015 to December 2017. During CEA, a bolus of ICG was injected intravenously before and after resecting the atheroma. Additionally, we performed immunohistochemistry using CD68 (a surface marker of macrophages), CD117 (a surface marker of mast cells), and CD4 and CD8 (surface markers of T-cells) antibodies to analyze the resected plaque specimens. Results : The density of active vasa vasorum was observed in all patients using ICG-VA. The vasa vasorum externa (VVE) and interna (VVI) were seen in 11 (16%) and 57 patients (82.6%), respectively. Macroscopically, the VVE-type patterns were strongly associated with preoperative angiographic instability (81.8%, p=0.005) and carotid plaque vulnerability (90.9%, p=0.017). In contrast, the VVI-type patterns were weakly associated with angiographic instability (31.6%) and plaque vulnerability (49.1%). CD68-stained macrophages and CD117-stained mast cells were observed more frequently in unstable plaques than in stable plaques (p<0.0001, p=0.002, respectively). Conclusion : The early appearance of VVE, along with the presence of many microvessel channels that provided nutrients to the developing and expanding atheroma during ICG-VA, was strongly associated with unstable carotid plaques. The degree of infiltration of macrophages and mast cells is possibly related to the formation of unstable plaques.

• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.590-597
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• 2020

Objective : Covered stenting is an optional strategy for traumatic carotid pseudoaneurysm, especially in malignant conditions of potential rupture, but the long-term outcomes are not clear. Our aim was to determine if covered stenting is an effective option for traumatic carotid pseudoaneurysm with promising long-term outcomes. Methods : Self-expanding Viabahn and balloon-expandable Willis covered stents were separately implanted for extra- and intracranial traumatic carotid pseudoaneurysm. The covered stent was placed across the distal and proximal pseudoaneurysm leakage under roadmap guidance. Procedural success was defined as technical success (complete exclusion of the pseudoaneurysm and patency of the parent artery) without a primary end point (any stroke or death within 30 days after the procedure). Long-term outcomes were evaluated as ischemic stroke in the territory of the qualifying artery by clinical follow-up through outpatient or telephone consultation and as the exclusion of the pseudoaneurysm and patency of the parent artery by imaging follow-up through angiography. Results : Five patients with traumatic carotid pseudoaneurysm who underwent covered stenting were enrolled. The procedural success rate was 100%. No ischemic stroke in the territory of the qualifying artery was recorded in any of the five patients during a mean clinical follow-up of 44±16 months. Complete exclusion of the pseudoaneurysm and patency of the parent artery were maintained in all five patients during a mean imaging follow-up of 39±16 months. Conclusion : Satisfactory procedural and long-term outcomes were obtained, suggesting that covered stenting is an effective option for traumatic carotid pseudoaneurysm.

• Journal of Korean Neurosurgical Society
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• v.54 no.2
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• pp.93-99
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• 2013

Objective : Neurologic complications during carotid artery stenting (CAS) are usually associated with distal embolic event. These embolic incident during CAS are highly associated with the carotid plaque instability. The current study was undertaken to identify the angiographic characteristics of carotid plaque vulnerability, which was represented as filling defect in the cerebral protection filters during CAS. Methods : A total of 107 patients underwent CAS with use of a distal protection filter. Angiographic carotid plaque surface morphology was classified as smooth, irregular, and ulcerated. To determine predictable factors of filling defect in the protection filters, 11 variables were retrospectively analyzed which might influence filling defect in the protection filters during CAS. Results : Filling defects during CAS were presented in the 33 cerebral protection filters. In multivariate analysis, angiographic ulceration [odds ratio (OR), 6.60; 95% confidence interval (CI) : 2.24, 19.4; p=0.001], higher stenosis degree (OR, 1.06; 95% CI : 1.00, 1.12; p=0.039), and coexistent thrombus (OR, 7.58; 95% CI : 1.69, 34.05; p=0.08) were highly associated with filling defect in the cerebral protection devices during CAS. Among several variables, angiographic surface ulceration was the only significant factor associated with flow stagnation during CAS (OR, 4.11; 95% CI : 1.33, 12.72; p=0.014). Conclusion : Plaque surface morphology on carotid angiography can be a highly sensitive marker of plaque instability during CAS. The independent risk factors for filling defect in the filter devices during CAS were plaque ulceration, stenosis degree, and coexistent thrombus.

• Korean Journal of Animal Reproduction
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• v.22 no.1
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• pp.67-72
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• 1998

Nowadays many kinds of foreign breed horse and Korean native Cheju horse are raised in Korea. Horse has complicated structure and function to maintain normal health, and to overcome severe condition during gallop at full speed. Sometimes the disease take a bad turn becuase of difficulty of correct diagnosis for horse disease. In recent times, horse farm for fattening and reproduction is gradually increasing. However, thoracic disease and abdominal disease are frequently occuring by defect in raising management. But the diagnosis of these kinds of disease is difficult by former diagnostic method. Ultrasonographic diagnostic method is a method to slove the problem. In abroad, nowadays ultrasonography has been reported for circulatory organs and abdomonal organs in horse, cattle, sheep, and dog, and the importance of ultrasonographic diagnosis is recognized in veterinary clinical medicine. In the country, ultrasonography of Korean native goat, cattle and dog was recently reported, but there was no report for the ultrasonography of horse. So, ultrasonogram for the thyroid glands, jugular vein and carotid artery was evaluated in Cheju horse and Thoroughbred horse. Thyroid gland, jugular vein and carotid artery were determined on both sides of neck. The length of right thyroid lobe at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 54.8, 45.1, 46.1 and 42.2 mm, respectively. The width of right thyroid lobe at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 18.1, 14.3, 14.6 and 14.2 mm, respectively. The height of right thyroid lobe at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 27.3, 25.6, 26.2 and 25.5 mm, respectively. Similar ultrasonographic measurements were obtained for the left thyroid gland. The internal diameter of left jugular vein at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 10.6, 9.7, 10.5 and 9.2 mm, respectively. Similar ultrasonographic measurements were obtained for the right jugular vein. The internal diameter of right carotid artery at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 9.5, 8.8, 9.1 and 8.5 mm, respectively. Similar ultrasonographic measurements were obtained for the left carotid artery. It is concluded that the ultrasonographic values of this study provides references for the diagnosis of morphologic changes in the thyroid gland, jugular vein and carotid artery in Korean native Cheju horse and Thoroughbred horse.

• Journal of the Korean Society of Radiology
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• v.16 no.3
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• pp.309-317
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• 2022

It is reported that social distancing caused by the corona pandemic has resulted in a decrease in physical activity, and a decrease in muscle mass due to this increases the risk of vascular disease. Therefore, in this study, the risk of carotid intima media thickness was evaluated by measuring the thickness of CIMT, and the differences in variables according to gender were analyzed. From January 2022 to May 2022, a total of 220 people (121 males, 99 females) who performed blood tests, carotid ultrasound, and body composition analysis among those who visited the health check-up center of Busan H Hospital were included in this study. Significant differences in risk factors according to gender were analyzed using the chi-square test. The cut-off values of variables that can predict the risk of carotid intima media thickness were calculated, and the accuracy was evaluated by calculating the area under the curve, sensitivity, and specificity. As a result of the difference analysis, the higher the total cholesterol in men and the appendicular skeletal muscle index in women, the higher the risk of carotid intima media thickness. The cut-off value for predicting the risk of carotid intima media thickness was calculated to be greater than 199 mg/dL of total cholesterol in the male group and less than 5.9 kg/m² of the appendicular skeletal muscle index in the female group. As a result of this study, the higher the total cholesterol in men and the lower the appendicular skeletal muscle index in women, the higher the risk of increased CIMT. Therefore, in women, the appendicular skeletal muscle index is expected to serve as an indicator to predict and prevent vascular changes at an early stage.

• 대한예방의학회:학술대회논문집
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• 1994.02b
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• pp.169-179
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• 1994

B-mode ultrasound is being used to assess carotid atherosclerosis in epidemiological studies and clinical trials. Recently the interpretation of measurements made from ultrasound images has been questioned. This study examines the anatomical correlates of B-mode ultrasound of carotid arteries in vitro and in situ in cadavers. Twenty-seven segments of human carotid artery were collected at autopsy. pressure perfusion fixed in buffered 2.5% gluteraldehyde and 4% paraformaldehyde and imaged using an ATL UM-8 (10 MHz single crystal mechanical probe). Each artery was then frozen, sectioned and stained with van Gieson or elastin van Gieson. The thickness of the intima. media and adventitia were measured 'to an accuracy of 0.01 mm from histological sections using a calibrated eye graticule on a light microscope. Shrinkage artifact induced by histological preparation was determined to be 7.8%. Digitised ultra sound images of the artery wall were analysed off-line. The distance from the leading edge of the first interface ($LE_{1}$) to the leading edge of the second interface ($LE_2$) was measured using a dedicated programme. $LE_{1}$-$LE_{2}$ measurements were correlated against histological measurements corrected for shrinkage. Mean values for the far wall were: ultra sound $LE_{1}$-$LE_{2}$ (0.97 mm, S.D. 0.26), total wall thickness (1.05 mm, S.D. 0.37), adventitia (0.35 mm, S.D. 0.16), media (0.61 mm, S.D. 0.18). intima (0.09 mm, S.D. 0.13). Ultrasound measurements corresponded best with total wall thickness, rather than elastin or the intima-media complex. Excision of part of the intima plus media or removal of the adventitia resulted in a corresponding decrease in the $LE_{1}$-$LE_{2}$ distance of the B-mode image. Furthermore. increased wall thickness due to intimal atherosclerotic thickening correlated well with $LE_{1}$-$LE_{2}$ distance of the B-mode images. B-mode images obtained from the carotid arteries in situ in four cadavers also corresponded best with total wall thickness measured from histological sections and not with the thickness of the intima plus media. In conclusion, the $LE_{1}$-$LE_{2}$ distance measured on B-mode images of the carotid artery best represents total wall thickness of intima plus media plus adventitia and not intima plus media alone.

• Korean Journal of Radiology
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• v.24 no.4
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• pp.338-348
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• 2023

Objective: Patients with a history of ischemic stroke are at risk for a second ischemic stroke. This study aimed to investigate the relationship between carotid plaque enhancement on perfluorobutane microbubble contrast-enhanced ultrasonography (CEUS) and future recurrent stroke, and to determine whether plaque enhancement can contribute to risk assessment for recurrent stroke compared with the Essen Stroke Risk Score (ESRS). Materials and Methods: This prospective study screened 151 patients with recent ischemic stroke and carotid atherosclerotic plaques at our hospital between August 2020 and December 2020. A total of 149 eligible patients underwent carotid CEUS, and 130 patients who were followed up for 15-27 months or until stroke recurrence were analyzed. Plaque enhancement on CEUS was investigated as a possible risk factor for stroke recurrence and as a possible adjunct to ESRS. Results: During follow-up, 25 patients (19.2%) experienced recurrent stroke. Patients with plaque enhancement on CEUS had an increased risk of stroke recurrence events (22/73, 30.1%) compared to those without plaque enhancement (3/57, 5.3%), with an adjusted hazard ratio (HR) of 38.264 (95% confidence interval [CI]:14.975-97.767; P < 0.001) according to a multivariable Cox proportional hazards model analysis, indicating that the presence of carotid plaque enhancement was a significant independent predictor of recurrent stroke. When plaque enhancement was added to the ESRS, the HR for stroke recurrence in the high-risk group compared to that in the low-risk group (2.188; 95% CI, 0.025-3.388) was greater than that of the ESRS alone (1.706; 95% CI, 0.810-9.014). A net of 32.0% of the recurrence group was reclassified upward appropriately by the addition of plaque enhancement to the ESRS. Conclusion: Carotid plaque enhancement was a significant and independent predictor of stroke recurrence in patients with ischemic stroke. Furthermore, the addition of plaque enhancement improved the risk stratification capability of the ESRS.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.448-452
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• 2017

Background: Proper monitoring of cerebral perfusion during carotid artery surgery is crucial for determining if a shunt is needed. We compared the safety and reliability of near-infrared spectroscopy (NIRS) w ith transcranial Doppler (TCD) for cerebral monitoring. Methods: This single-center, retrospective review was conducted on patients who underwent carotid endarterectomy (CEA) using selective shunt-based TCD or NIRS at Daegu Catholic University Medical Center from November 2009 to June 2016. Postoperative complications were the primary outcome, and the distribution of risk factors between the 2 groups was compared. Results: The medical records of 74 patients (45 TCD, 29 NIRS) were reviewed. The demographic characteristics were similar between the 2 groups. One TCD patient died within the 30-day postoperative period. Postoperative stroke (n=4, p=0.15) and neurologic complications (n=10, p=0.005) were only reported in the TCD group. Shunt usage was 44.4% and 10.3% in the TCD and NIRS groups, respectively (p=0.002). Conclusion: NIRS-based selective shunting during CEA seems to be safe and reliable for monitoring cerebral perfusion in terms of postoperative stroke and neurologic symptoms. It also reduces unnecessary shunt usage.