• Journal of the Korean Society of Radiology
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• v.10 no.3
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• pp.187-193
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• 2016

In this study, we performed the carotid artery ultrasound targeting 140 subjects who have conducted to evaluate the changes in intima-media thickness(IMT) and plaque correlated with the presence or absence of a hematological test of the carotid artery. Considering that the IMT thickness more than 1mm is abnormal based on the carotid artery ultrasound to assess the presence or absence of plaque, and examined the correlation by classifying the blood lipid value and the fasting blood glucose level through the serum test. Consequently, the fasting blood glucose level is being analyzed as independent predictors of causing dental plaque(p=0.033), cut off value was determined as 126 mg/dL(sensitivity 56.25%, specificity 68.38%) in ROC curve analysis. Furthermore, the odds ratio appeared 1.01 times the value in the Logistic regression. Therefore, it seemed that the necessity to prospective studies in a number of subjects are considered, and also taking into account a number of blood test values along with the sonography of the carotid artery as a valuable part for effective primary prevention and follow-up observation of the cardiac and brain vascular disease is highly recommended.

• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.373-379
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• 2020

Carotid endarterectomy (CEA) is the main procedure in carotid surgery, as well as the most frequent vascular procedure. Two techniques of CEA are available : eversion and conventional plus patch angioplasty. Eversion CEA is anatomic procedure that reduces ischemic and total operative time. Simultaneous correction of the joined carotid kinking and coiling is possible, easy and safe, while the usage of patch is excluded. Thanks to oblique shape of anastomosis, eversion CEA is associated with low risk of long-term restenosis. The false anastomotic aneurysms occurrence is very rare, almost impossible after eversion CEA. However, the usage of carotid shunt during eversion CEA is not always simple, while proximal or distal extension of the carotid plaque can make eversion CEA more difficult and risky. Eversion CEA should be the first choice in carotid surgery. Conventional CEA is indicated in cases when carotid plaque is extended more than usual, as well as, if the usage of carotid shunt is necessary.

• 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.

• Investigative Magnetic Resonance Imaging
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• v.21 no.4
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• pp.242-251
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• 2017

Purpose: To investigate the association of carotid intraplaque hemorrhage (IPH) with acute cerebral ischemic events and progression of stenosis using magnetic resonance (MR) imaging. Materials and Methods: From April 2014 to December 2016, 53 patients underwent carotid plaque MR imaging, including magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequence. A total of 66 carotid arteries in 53 patients had carotid stenosis, and they were included in this study. Carotid arteries were classified according to the presence of IPH, the age of hemorrhage, and degree of stenosis. We assessed ipsilateral cerebrovascular event rates and progression of stenosis between the IPH and no-IPH groups. Results: Of the 61 carotid arteries assessed, 34 (56%) had IPH, and 27 (44%) had no IPH. Acute cerebral ischemic events were more frequent in the IPH group (47% vs. 22%, P = 0.045), especially in the < 30%-stenosis group (100% vs. 0%, P = 0.028). However, there was no significant difference in the incidence of ischemic events according to the age of hemorrhage (50% vs. 44%, P = 0.492). Among the 61 carotid arteries, 20 carotid arteries had previously undergone carotid artery imaging and were evaluated for plaque progression. The trend for progression of stenosis favored the IPH group versus the no-IPH group, with a marginal P-value ($20%{\pm}12.7$ vs. $9.6%{\pm}5.7$, P = 0.063). Conclusion: IPH was associated with an increased incidence of acute ischemic events, especially in the mild-stenosis group and it was also associated with progression of stenosis. Evaluation of the carotid IPH by carotid plaque MR could improve discrimination of carotid plaques that cause ischemic events and progression of stenosis.

• Journal of radiological science and technology
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• v.32 no.2
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• pp.161-168
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• 2009

The carotid intima-media thickness (IMT) is an early structural marker of the atherosclerotic process and is the only non-invasive test that is currently recommended by the American Heart Association for evaluation of the risk. However, use of this parameter has a limitation because it assumes uniform thickness throughout the blood vessel, whereas atherosclerosis is a focal phenomenon that is confined to intima. In fact, plaque can be found along the atherosclerotic blood vessels even though its value is unknown. The aim of this study is to analyze the carotid plaque and IMT in the stroke patients. We investigated the patients with ischemic stroke, who were admitted to the department of neurology at the Stroke Special Hospital from January to March 2008. After the carotid IMT and plaque were assessed by B-mode ultrasonography, IMT and carotid plaque to risk variables (age, sex) were analyzed. The distribution of CCA IMT was significantly different in terms of age (p = 0.004). Likewise, the distribution of carotid plaque was also significantly different in terms of age (p = 0.006). Carotid plaque was 69 and 92% in normal and abnormal CCA IMTs respectively. The results showed that the CCA IMT was closely associated with carotid plaque.

• Journal of Preventive Medicine and Public Health
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• v.44 no.6
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• pp.260-266
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• 2011

Objectives: We evaluated the association between common carotid artery intima-media thickness (CCA-IMT), brachialankle pulse wave velocity (baPWV), carotid plaque, and peripheral arterial disease (PAD) as indicators of macroangiopathy and diabetic retinopathy as an indicator of microangiopathy in type 2 diabetic patients. Methods: We analyzed 605 type 2 diabetic patients registered at a public health center in Korea. Following overnight fasting, venous blood and urine samples were collected and analyzed. The CCA-IMT, levels of carotid plaque, baPWV, and ankle-brachial index (ABI) of the subjects were assessed. We used non-mydriatic fundus photography to diagnose diabetic retinopathy. Multiple logistic regression analyses were used to evaluate the association between macroangiopathy and diabetic retinopathy. CCA-IMT and baPWV were divided into tertiles: CCA-IMT, 0.39 to 0.65 mm, 0.66 to 0.78 mm, and 0.79 to 1.30 mm; baPWV, 9.9 to 15.8 m/s, 15.9 to 18.9 m/s, and 19.0 to 38.0 m/s. Results: The association between baPWV and diabetic retinopathy remained significant after adjustment, with an increasing odds ratio (OR) in the second tertile (OR, 2.41; 95% confidence interval [CI], 1.27 to 4.55) and the third tertile (OR, 4.63; 95% CI, 2.33 to 9.21). No significant differences were observed in carotid plaque, PAD, and each tertile of CCA-IMT. Conclusions: BaPWV was associated with diabetic retinopathy, while CCA-IMT, carotid plaque, and PAD were not. This study suggests that the association between macroangiopathy and microangiopathy may be attributable to functional processes rather than structural processes within the vascular system.

• Journal of Preventive Medicine and Public Health
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• v.39 no.6
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• pp.477-484
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• 2006

Objectives : This study was conducted to examine the association between the carotid artery intima-media thickness (IMT), plaque and cardiovascular risk factors according to gender and age. Methods : The data used for this study were obtained from 1,507 subjects (691 men, 816 women), aged 20-74 years, who participated in 'Prevalence study of thyroid diseases' in two counties of Jeollanam-do Province during July and August of 2004. The body mass index (BMI) and waist hip ratio (WHR) were calculated by anthropometry The blood pressure, pulse rate, pulse pressure, total cholesterol, triglyceride, HDL cholesterol and fasting blood sugar level were also measured. Ultrasonography was used to measure the carotid artery IMT and plaque. IMT measurements were performed at 6 sites, including both common carotid arteries, and the bulb and internal carotid arteries. The definition of the 'mean IMT' was mean value obtained from these 6 sites. Results : The ${\pm}$ standard deviation IMT values were $0.65{\pm}0.14\;and\;0.60{\pm}0.13mm$ in men and women (p<0.001), respectively. The data were analyzed according to gender and the 50 year age groups. In a multiple linear regression analysis, age and hypertension were positively associated with the mean IMT in both men and women, aged<50 years. Age, total cholesterol and smoking (current) were positively associated with the mean IMT in men $(\geq50\;years)$. Age was positively associated with the mean IMT in women $(\geq50\;years)$, but the HDL cholesterol level was negatively associated. The prevalence of plaques was 44.2%(196/443) in men and 19.4%(89/459) in women, for those greater than 50 years of age. In a multiple logistic regression analysis, age (OR=1.090, 95%CI=1.053-1.129), HDL cholesterol (OR=0.964, 95%CI=0.944-0.984), total cholesterol (OR=1.009, 95%CI=1.002-1.017)and BMI (OH=0.896, 95%CI=0.818-0.983) were independently associated with plaques in men; whereas, age (OR=1.057, 95%CI=1.012-1.103), HDL cholesterol (OR=0.959, 95%CI=0.932-0.986), pulse pressure (OR=1.029, 95%CI=1.007-1.050) and triglycerides (OR=0.531, 95%CI=0.300-0.941) were independently associated with plaques in women. Conclusions: There were significant gender and aging differences in the association between the IMT, plaque and cardiovascular risk factors. Therefore, for the prevention of atherosclerosis, selective approaches should be considered with regard to gender and age factors.

• Korean Journal of Radiology
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• v.21 no.7
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• pp.900-907
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• 2020

Objective: To investigate the predictive value of intraplaque neovascularization (IPN) for cardiovascular outcomes. Materials and Methods: We evaluated 217 patients with coronary artery disease (CAD) (158 men; mean age, 68 ± 10 years) with a maximal carotid plaque thickness ≥ 1.5 mm for the presence of IPN using contrast-enhanced ultrasonography. We compared patients with (n = 116) and without (n = 101) IPN during the follow-up period and investigated the predictors of major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, coronary artery revascularization, and transient ischemic accident/stroke. Results: During the mean follow-up period of 995 ± 610 days, the MACE rate was 6% (13/217). Patients with IPN had a higher maximal thickness than those without IPN (2.86 ± 1.01 vs. 2.61 ± 0.84 mm, p = 0.046). Common carotid artery-peak systolic velocity, left ventricular mass index (LVMI), and ventricular-vascular coupling index were significantly correlated with MACE. However, on multivariate Cox regression analysis, increased LVMI was independently related to MACE (p < 0.05). The presence of IPN could not predict MACE. Conclusion: The presence of IPN was related to a higher plaque thickness but could not predict cardiovascular outcomes better than conventional clinical factors in patients with CAD.

• Journal of health informatics and statistics
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• v.41 no.1
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• pp.49-56
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• 2016

Objectives: Carotid intima-media thickness (CIMT) and the presence of carotid artery plaque are widely used as preclinical markers of atherosclerosis. Due to operator dependency in measuring CIMT, it is important to evaluate the reliability of measuring CIMT and plaque between centers in a multicenter study. The purpose of this study is to evaluate the inter-rater reliability of CIMT and plaque presence among three clinical centers of the Cardiovascular and Metabolic Disease Etiology Research Center (CMERC). Methods: Twenty people without known cardiovascular disease (age 37-64) were enrolled during 2014-2015, and their left and right carotid arteries were examined repeatedly with ultrasonography for CIMT measurements at three clinical centers according to a predetermined protocol. Maximum and mean values of CIMT at distal common carotid artery were recorded. Plaque presence at a carotid artery was checked by an operator. The reliability of CIMT and carotid plaque presence was assessed using an intraclass correlation coefficient (ICC) and kappa statistics, respectively. Results: Calculated ICC was 0.647 (95% CI: 0.487-0.779) for maximum CIMT, and 0.758 (95% CI: 0.632- 0.854) for mean CIMT. In Bland Altman plot, most observed values were distributed within mean difference ${\pm}1.96$ SD ranges. Kappa statistics of plaque presence between two centers were 0.304 (center 1 and 2), 0.507 (center 1 and 3), and 0.606 (center 2 and 3), respectively, while Fleiss kappa for overall agreement was 0.445. Conclusions: The inter-rater reliability of CIMT measurements among three clinical centers turned out to be high, and the agreement of measuring carotid plaque presence was fair.

• Investigative Magnetic Resonance Imaging
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• v.16 no.2
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• pp.97-102
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• 2012

High-resolution carotid MRI allows visualization of carotid atherosclerotic plaque characteristics. MRI serves as a noninvasive option for the detection of active plaque inflammation and intraplaque hemorrhage. Significant gains in signal-tonoise ratio and contrast-to-noise ratio can be obtained for carotid atheroma imaging at 3T compared with 1.5T. Normalized wall index or wall area on MRI has shown its efficacy in monitoring the response after medical therapy. $T(2)^*$ quantification in carotid plaques before and after the administration of ultrasmall superparamagnetic iron oxide particles shows difference in response to treatment according to drug doses. In conclusion, high-resolution MRI is useful in the diagnosis and monitoring of carotid atherosclerotic plaques prone to transient ischemic attack and stroke.