• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.834-840
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• 2020

Objective : Carotid endarterectomy (CEA) is an effective surgical procedure for treating symptomatic or asymptomatic patients with carotid stenosis. Many neurosurgeons use a shunt to reduce perioperative ischemic complications. However, the use of shunting is still controversial, and the shunt procedure can cause several complications. In our institution, we used two types of modified arteriotomy suture techniques instead of using a shunt. Methods : In technique 1, to prevent ischemic complications, we sutured a third of the arteriotomy site from both ends after removing the plaque. Afterward, the unsutured middle third was isolated from the arterial lumen by placing a curved Satinsky clamp. And then, we opened all the clamped carotid arteries before finishing the suture. In technique 2, we sutured the arteriotomy site at the common carotid artery (CCA). We then placed a curved Satinsky clamp crossing from the sutured site to the carotid bifurcation, isolating the unsutured site at the internal carotid artery (ICA). After placing the Satinsky clamp, the CCA and external carotid artery (ECA) were opened to allow blood flow from CCA to ECA. By opening the ECA, ECA collateral flow via ECA-ICA anastomoses could help to reduce cerebral ischemia. Results : The modified suture methods can reduce the cerebral ischemia directly (technique 1) or via using collaterals (technique 2). The modified arteriotomy suture techniques are simple, safe, and applicable to almost all cases of CEA. Conclusion : Two modified arteriotomy suture techniques could reduce perioperative ischemic complications by reducing the cerebral ischemic time.

• 대한두경부종양학회지
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• 제17권2호
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• pp.221-225
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• 2001

Carotid body tumor is a rare benign tumor arising from the paraganglionic tissue of neural crest. Surgical management remains the prefered treatment. Large carotid body tumors frequently encircle the internal carotid and external carotid arteries, and extensive bleeding often complicates the resection, increasing the risk of carotid artery rupture and damage to major cranial nerves. Recent improvements in surgical techniques and selective embolization have lessened the risks of surgical excision, decreased blood loss, and diminished the time required for resection. The review of literatures revealed a few cases of the carotid body tumor with papillary carcinoma of the thyroid. We report a case of the huge carotid body tumor with papillary carcinoma of the thyroid, which was removed by 4 times of preoperative embolization and transcervical approach.

• Journal of Preventive Medicine and Public Health
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• 제40권5호
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• pp.411-417
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• 2007

Objectives: Although risk factors for coronary artery disease are also associated with increased carotid intima-media thickness (IMT), there is little information available on the asymptomatic, young adult population. We examined the association between multiple cardiovascular risk factors and the common carotid IMT in 280 young Korean adults. Methods: The data used for this study was obtained from 280 subjects (130 men and 150 women) aged 25 years who participated in the Kangwha Study follow-up examination in 2005. We measured cardiovascular risk factors, including anthropometries, blood pressure, blood chemistry, carotid ultrasonography, and reviewed questionnaires on health behaviors. Risk factors were defined as values above the sex-specific 75th percentile of systolic blood pressure, body mass index, total cholesterol/ high-density lipoprotein cholesterol ratio, fasting blood glucose and smoking status. Results: The mean carotid IMT${\pm}$standard deviation observed was $0.683{\pm}0.079mm$ in men and $0.678{\pm}0.067mm$ in women (p=0.567) and the evidence of plaque was not observed in any individuals. Mean carotid IMT increased with an increasing number of risk factors(p for trend <0.001) and carotid IMT values were 0.665 mm, 0.674 mm, 0.686 mm, 0.702 mm, and 0.748 mm for 0, 1, 2, 3, and 4 to 5 risk factors, respectively. The odds ratio for having the top quartile carotid IMT in men with 3 or more risk factors versus 0-2 risk factors was 5.09 (95% CI, 2.05-12.64). Conclusions: Current findings indicate the need for prevention and control of cardiovascular risk factors in young adults and more focus on those with multiple cardiovascular risk factors.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 1994년도 교수 연수회(역학)
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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.

• Journal of Korean Neurosurgical Society
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• 제61권2호
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• pp.282-286
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• 2018

True extracranial carotid artery aneurysms (ECCAs) are uncommon. Atherosclerosis is the most common etiological factor. Neck pain, a pulsatile mass and murmur at auscultation are the most common symptoms. ECCAs may exhibit severe clinical manifestations due to complications. Cases of rupture can be fatal. There is a risk of distal embolization and stroke in thrombosed cases. We discuss two cases of enlarged ECCA treated surgically in the light of the most recent literature.

• Journal of Korean Neurosurgical Society
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• 제45권5호
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• pp.300-302
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• 2009

The authors present a rare case of severe vasospasm following the rupture of arteriovenous fistula. On initial CT scan, hematoma in the corpus callosum and left inferior frontal region with surrounding cerebromalacia and all ventricles without apparent subarachnoid hemorrhage were seen. Angiograms showed arterivenous fistula but did not show cerebral vasospasm. Thirteen days after admission the neurological state of patient suddenly deteriorated and bilateral motor weaknesses developed. Following angiograms revealed severe narrowing on the supraclinoid portion of bilateral internal carotid arteries, bilateral anterior cerebral arteries and bilateral middle cerebral arteries. Transluminal angioplasty and intra-arterial papaverine infusion were performed. The patient remained stable with moderate neurologic deficits.

• Journal of Chest Surgery
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• 제45권2호
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• pp.95-100
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• 2012

Background: The purpose of this report is to describe the perioperative outcomes of standard carotid endarterectomy (CEA) with general anesthesia, routine shunting, and tissue patching in symptomatic carotid stenoses. Materials and Methods: Between October 2007 and July 2011, 22 patients with symptomatic carotid stenosis (male/female, 19/3; mean age, $67.2{\pm}9.4$ years) underwent a combined total of 23 CEAs using a standardized technique. The strict surgical protocol included general anesthesia and standard carotid bifurcation endarterectomy with routine shunting. The 8-French Pruitt-Inahara shunt was used in all the patients. Results: During the ischemic time, the shunts were inserted within 2.5 minutes, and 5 patients (22.7%) revealed ischemic cerebral signals (flat wave) in electroencephalographic monitoring but recovered soon after insertion of the shunt. The mean shunting time for CEA was $59.1{\pm}10.3$ minutes. There was no perioperative mortality or even minor stroke. All patients woke up in the operating room or the operative care room before being moved to the ward. One patient had difficulty swallowing due to hypoglossal nerve palsy, but had completely recovered by 1 month postsurgery. Conclusion: Routine shunting is suggested to be a safe and reliable method of brain perfusion and protection during CEA in symptomatic carotid stenoses.

• Journal of Chest Surgery
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• 제47권1호
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• pp.20-25
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• 2014

Background: Symptomatic or asymptomatic patients with significant carotid artery stenosis (range, 70% to 99%) generally undergo either carotid artery endarterectomy (CEA) or carotid artery stenting (CAS) to prevent stroke. In this study, we evaluated the cost effectiveness of these two treatment modalities. Methods: A total of 47 patients (mean age, $67.1{\pm}9.1$ years; male, 87.2%) undergoing either CEA (n=28) or CAS (n=19) for the treatment of significant carotid artery stenosis were enrolled in this study. Hospitalization costs were subdivided into three parts, namely pre-procedure, procedure and resource, and post-procedure costs. Results: Total hospitalization costs were similar in both groups of CEA and CAS (6,377 thousand won [TW] vs. 6,703 TW, p=0.255); however, the total cost minus the pre-procedure cost was higher in the CAS group than in the CEA group (4,948 TW vs. 5,941 TW, p<0.0001). The pre-procedure cost of the CEA group was higher than that of the CAS group (1,429 TW vs. 762 TW, p<0.0001). However, the procedure and resource cost was higher in the CAS group because the resource cost was approximately three times higher in the CAS group than in the CEA group. The post-procedure cost was higher in the CEA group because hospital stays were approximately two times longer. Conclusion: The total hospitalization cost was not different between the CEA and the CAS groups. The pre-procedure cost was high in the CEA group, but the cost from procedure onset to discharge, including the resource cost, was significantly lower in this group.

• Journal of Korean Neurosurgical Society
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• 제49권5호
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• pp.287-289
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• 2011

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

• 대한수의학회지
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• 제56권3호
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• pp.177-181
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• 2016

Mini-pigs have been widely employed in preclinical studies to explore new therapeutic strategies for diseases of the human urinary system; however, the normal reference of the renal artery has not been clearly investigated in the mini-pig model. Therefore, we aimed to establish a normal reference of the radiological morphology of the renal artery in mini-pigs by renal angiography via catheterization of the carotid artery. The renal angiographies obtained from 15 mini-pigs were evaluated to determine the orifice from the aorta, facing direction, size and the number of branches of renal arteries. Cranio-laterally facing renal arteries with 2 distal branches were mainly observed in the renal artery of mini-pigs. Both sides of the renal artery presented symmetrical sizes; however, the right renal artery orifice from the aorta was located more cranially than the left counterpart. The results of this study will contribute to radiological diagnosis of the renal artery as well as preclinical studies of mini-pigs.