• Journal of radiological science and technology
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• v.42 no.5
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• pp.357-363
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• 2019

To the basic information of patients with subarachnoid hemorrhage due to rupture of cerebral aneurysm treated with coil embolization, and to identify the general trend of treatment through classification according to hospitalization route, residence distribution, location and size of cerebral aneurysm, and procedure. A total of 164 patients with ruptured cerebral aneurysms treated with coil embolization were 54(32.9%) males and 110(67.1%) females. The sex and frequency of occurrence by age group were the most in 50s(31.3%), and among them, females were the most. The hospitalization route was the most common in 122(74.4%) people who were admitted to the emergency room through 119 evacuation, 79(48.2%) patients lived in where hospitals belong to the hospital. The season had 23(14%) in December, 18(11%) in January, 15(9.1%) in February, and the anterior circulation was 153(93%). The largest size was 5-7 mm found in 63(38.4%) patients. Patients underwent initial coil embolization for subarachnoid hemorrhage due to cerebral aneurysm rupture treated more patients than the incidence of the population. As a result of cerebral aneurysm rupture was seasonally affected, and winter occurs more frequently, female than male, age 50 is most common, and ruptured cerebral aneurysm is 5-7 mm in size.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.518-526
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• 2017

Objective : Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. Methods : We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014. Thromboembolism occurred in 20 patients (7.4%), including 14 cases of ruptured aneurysms and 6 cases of unruptured aneurysms. The most common site of aneurysms was the anterior communicating artery (n=8), followed by middle cerebral artery (n=6). When we found an enlarged thromboembolism during coil embolization, we tried to dissolve it using tirofiban administered via IA and IV loading ($5{\mu}g/kg$, respectively) for 3-5 minutes followed by IV maintenance ($0.08{\mu}g/kg/min$) for approximately 4-24 hours. Results : In 4 of 5 patients with total vessel occlusion, the vessel was recanalized to Thrombolysis in Cerebral Infarction Perfusion Scale (TICI) grade 3, and in 1 patient to TICI grade 2a. In 2 patients with partial vessel occlusion and 13 patients with minimal occlusion, the vessel recanalized to TICI grade 3. Irrelevant intracerebral hemorrhage was noted in 1 patient (5%), and thromboemboli-related cerebral infarction developed in 5 patients (25%), of which only 1 (5%) was symptomatic. Conclusion : IA/IV infusion and IV maintenance with tirofiban appear to be an effective rescue treatment for thromboembolism during endovascular coil embolization in patients with ruptured or unruptured cerebral aneurysms.

• Journal of Korean Neurosurgical Society
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• v.43 no.6
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• pp.275-280
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• 2008

Objective : In order to assess the incidence of thromboembolic events and their clinical presentations, the present study prospectively examined routine brain magnetic resonance images (MRI) taken within 48 hours after a coil embolization of cerebral aneurysms. Methods : From January 2006 to January 2008, 163 cases of coil embolization of cerebral aneurysm were performed along with routine brain MRI, including diffusion-weighted magnetic resonance (DW-MR) imaging, within 48 hours after the embolization of the aneurysm to detect the silent thromboembolic events regardless of any neurological changes. If any neurological changes were observed, an immediate brain MRI follow-up was performed. High-signal-intensity lesions in the DW-MR images were considered as acute thromboembolic events and the number and locations of the lesions were also recorded. Results : Among the 163 coil embolization cases, 98(60.1%) showed high-signal intensities in the DW-MR imaging follow-up, 66 cases (67.0%) involved the eloquent area and only 6cases (6.0%) showed focal neurological symptoms correlated to the DW-MR findings. The incidence of DW-MR lesions was higher in older patients (${\geq}60$ yrs) when compared to younger patients (<60 yrs) (p=0.002, odd's ratio=1.043). The older patients also showed a higher incidence of abnormal DW-MR signals in aneurysm-unrelated lesions (p=0.0003, odd's ratio=5.078). Conclusion : The incidence of symptomatic thromboembolic attacks after coil embolization of the cerebral aneurysm was found to be lower than that reported in previous studies. While DW-MR imaging revealed a higher number of thromboembolic events, most of these were clinically silent and transient and showed favorable clinical outcomes. However, the incidence of DW-MR abnormalities was higher in older patients, along with unpredictable thromboembolic events on DW-MR images. Thus, in order to provide adequate and timely treatment and to minimize neurological sequelae, a routine DW-MR follow-up after coil embolization of cerebral aneurysms might be helpful, especially in older patients.

• Journal of Korean Neurosurgical Society
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• v.66 no.2
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• pp.205-210
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• 2023

Delayed cerebral ischemia (DCI) remains a devastating complication in subarachnoid hemorrhage (SAH), however, there were no present reports that is associated with a ruptured spinal arteriovenous fistula (sAVF). We would like to present a rare case of DCI following embolization of a ruptured perimedullary sAVF. Initially, the patient clinical symptoms mimic a SAH caused by a ruptured intracranial aneurysm. Further evaluation revealed that the SAH was caused by a ruptured perimedullary sAVF and the patient's condition improved following the embolization procedure. Three days later, the patient developed an acute left-sided facial and motor weakness, which persisted until the patient was discharged on the day-15 onset. A magnetic resonance imaging and angiography is performed 1.5 years after discharge and revealed no signs of cerebral infarction and hemorrhage. In this paper, we reported DCI after embolization in a ruptured sAVF with SAH, supported by evidence from the current literature. We would like to also stress the importance of complete spinal and cerebral vessel imaging to reveal the underlying abnormalities and determine the most appropriate intervention.

• Journal of radiological science and technology
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• v.45 no.5
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• pp.407-412
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• 2022

Cerebral aneurysm coil embolization has the advantages of accurate, low patient burden, and fast recovery time, but efforts are needed to reduce dose due to the burden of exposure radiation dose during interventional procedures. In this study, the area dose product(DAP/Gy·cm²) and fluoro time(min) according to the size of the aneurysm and the location of aneurysm were investigated according to insurance recognition regulations aneurysm classification cerebral aneurysm coil embolization. According to the research method, classification according to the size and location of the aneurysm is first, the size of the aneurysm is divided into less than 4mm, more than 4mm to less than 8mm, and more than 8mm, and second, the dose to the area based on the location site (DAP/Gy·cm²) and fluoro time(min) based on the location site were observed. As a result, the location of the cerebral aneurysm procedure was found to be the Paraclinoid site. During cerebral aneurysm coil embolization, the area dose was 107 Gy·cm² and fluoro time was 47.41 minutes, showing lower results than domestic studies, and when comparing the area dose product with foreign studies, the area dose product results were similar to that of Turkey and Saudi Arabia. It is expected that it can be used as an objective analysis indicator to establish diagnostic reference levels (DRLs) and patient radiation defense guidelines according to the size of cerebral aneurysm and location of cerebral aneurysm procedures during interventional procedures.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.411-413
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• 2007

We report on a diabetic 52-year-old man who complained ocular floating sensation, headache and dizziness, in whom a left parieto-occipital dural ateriovenous fistulas [DAVFs], fed by bilateral superficial temporal arteries and occipital artery, drained into the cortical vein of the left parieto-occipital convexity. Because the patient's chief complaint was ocular symptom for diabetic retinopathy, we initially didn't consider an DAVFs until brain magnetic resonance imaging [MRI] was done. Diffusion-weighted brain MRI revealed acute cerebral infarction and microhemorrhage in the lesion. Transarterial embolization with mixture of glue and lipiodol obliterated the DAVFs completely. Although the DAVFs fed by multi-arteries, the fistulous portion has been disappeared after embolization via an only left occipital artery Endovascular embolization of the fistula led to symptomatic improvement, except ocular discomfort.

• Journal of Korean Neurosurgical Society
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• v.65 no.4
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• pp.598-602
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• 2022

Development of de novo dural arteriovenous fistula (DAVF) at a different site after resolution of an initial DAVF, is rare. Here we report two cases, which we encountered in our hospital. A 68-year-old woman presented with pulsatile tinnitus on the left side. Cerebral angiography demonstrated a left anterior condylar confluence (ACC) DVAF and she underwent transvenous embolization. Four years after this treatment, she presented with tinnitus on the left side, and cerebral angiography revealed a right DAVF around the sinus of the lesser sphenoid wing. Another 69-year-old woman presented with left-sided orbital bruits, chemosis, and conjunctival hyperemia. Cerebral angiography showed left cavernous sinus (CS) DAVF, for which she underwent transvenous embolization for CS DAVF. One year later, she developed a left ACC and transverse-sigmoid sinus (TSS) DAVF.

• Journal of the Korean Society of Visualization
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• v.21 no.1
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• pp.80-93
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• 2023

We performed numerical simulations of blood flow in an arterial cerebral artery aneurysm to investigate the hemodynamic behavior after coil embolization. A patient-specific model was created based on CTA data. We also conducted the coil embolization simulation to obtain the coil placement within the aneurysm. Blood was assumed to be an incompressible Newtonian fluid, and both the vessel and coil were considered rigid walls. The pulsatile boundary condition was applied at the inlet, and the outflow boundary conditions were used at the outlets. Our findings demonstrated that the coil embolization significantly reduces the blood volume flowrate entering the aneurysm by effectively blocking the inflow jet, leading to a decrease in both TAWSS and WSS, especially at the systolic peak in the impingement zone. While several high OSI regions disappeared over the aneurysm surface, we observed high OSI regions with a relatively small area where the coil did not completely occlude the aneurysm. Overall, these results quantitatively analyzed the effectiveness of coil embolization by focusing on hemodynamic indicators, potentially preventing aneurysm rupture. The present work could contribute to the development of patient-specific coil embolization.

• Journal of Korean Neurosurgical Society
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• v.47 no.5
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• pp.406-408
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• 2010

Middle cerebral artery (MCA) fusiform aneurysms often have an unfavorable geometry that may limit surgical or endovascular treatment. Herein, we present a case of a fusiform aneurysm of the proximal MCA, which was successfully treated using stent-assisted coil embolization. A 42-year-old man presented with repeated headache and syncope. Five years earlier, a right MCA aneurysm had been treated by aneurismal wrapping. Magnetic resonance images (MRI) revealed a partially-thrombosed proximal MCA aneurysm at the right perisylvian region. Digital subtraction angiography (DSA) revealed a multilobulated fusiform-shaped aneurysm. The patient underwent stent-assisted coil embolization under general anesthesia and symptoms resolved postoperatively. A three-month follow-up angiography revealed no recanalization of the aneurysm and indicated tolerable blood flow through the right MCA, as compared to the preoperative angiography. We suggest that in selected patients, stent-assisted coil embolization of proximal MCA fusiform aneurysms can be an effective treatment modality.

• Journal of Korean Neurosurgical Society
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• v.43 no.1
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• pp.21-25
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• 2008

Objective : Both endovascular coil embolization and microsurgical clipping are now firmly established as treatment options for the management of cerebral aneurysms. Moreover, they are sometimes used as complementary approaches each other. This study retrospectively analyzed our experience with endovascular and microsurgical procedures as complementary approaches in treating a single aneurysm. Methods : Nineteen patients with intracranial aneurysm were managed with both endovascular and microsurgical treatments. All of the aneurysms were located in the anterior circulation. Eighteen patients presented with SAH, and 14 aneurysms had diameters of less than 10 mm, and five had diameters of 10-25 mm. Results : Thirteen of the 19 patients were initially treated with endovascular coil embolization, followed by microsurgical management. Of the 13 patients, 9 patients had intraprocedural complications during coil embolization (intraprocedural rupture, coil protrusion, coil migration), rebleeding with regrowth of aneurysm in two patients, residual sac in one patient, and coil compaction in one patient. Six patients who had undergone microsurgical clipping were followed by coil embolization because of a residual aneurysm sac in four patients, and regrowth in two patients. Conclusion : In intracranial aneurysms involving procedural endovascular complications or incomplete coil embolization and failed microsurgical clipping, because of anatomical and/or technical difficulties, the combined and complementary therapy with endovascular coiling and microsurgical clipping are valuable in providing the best outcome.