• Journal of Korean Neurosurgical Society
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• v.62 no.2
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• pp.201-208
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• 2019

Objective : In patients with internal carotid artery (ICA) occlusion, collateral middle cerebral artery (MCA) flow has a protective role against ischemia. However, some of these patients may experience initial major neurological deficits and major worsening on following days. Thus, we investigated the safety and efficacy of endovascular treatment (EVT) for ICA occlusion with collateral MCA flow by comparing clinical outcomes of medical treatment versus EVT. Methods : The inclusion criteria were as follows : 1) acute ischemic stroke with ICA occlusion and presence of collateral MCA flow on transfemoral cerebral angiography (TFCA) and 2) hospital arrival within 12 hours from symptom onset. The treatment strategy was made by the attending physician based on the patient's clinical status and results of TFCA. Results : Eighty-one patients were included (30 medical treatment, 51 EVT). The EVT group revealed a high incidence of intracranial ICA occlusion, longer ipsilesional MCA contrast filling time, and a similar rate of favorable clinical outcome despite a higher mean baseline the National Institutes of Health Stroke Scale (NIHSS) score. By binary logistic regression analysis, intravenous recombinant tissue plasminogen activator and EVT were independent predictors of favorable clinical outcome. In subgroup analysis based on stroke etiology, the non-atherosclerotic group showed a higher baseline NIHSS score, higher incidence of EVT, and a higher rate of distal embolization during EVT in comparison with the atherosclerotic group. Conclusion : In patients with ICA occlusion and collateral MCA flow, decisions regarding treatment strategy based on TFCA can help achieve favorable clinical outcomes. EVT strategy with respect to etiology of ICA occlusion might help achieve better angiographic outcomes.

• Journal of Chest Surgery
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• v.17 no.3
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• pp.488-491
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• 1984

Vascular injuries from gun shot wound is rare in these days, in Korea. A Case of false aneurysm of the right common carotid artery due to penetrating injury to the neck by carbine. The confirmatory diagnosis was made by right carotid angiogram which revealed bean-sized aneurysmal sac at the mid-portion of the right common carotid artery. Despite of no symptoms, emergency false aneurysmectomy and reconstruction with on-lay vein patch graft using left greater saphenous vein for threat of rupture and embolization from mural thrombi. During repair of common carotid artery, cerebral circulation was maintained with internal shunt. The postoperative course was uneventful except limit of motion of right upper extremity due to initial injury.

• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.235-237
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• 2007

We describe a case of an unruptured basilar top aneurysm that was associated with early rupture after incomplete coiling. A 62-year-old woman with a history of several small infarctions has undergone coiling of unruptured basilar top aneurysm. Two weeks after initial coiling the patient presented with Hunt and Hess grade IV subarachnoid hemorrhage consistent with a ruptured basilar top aneurysm. Repeat angiography revealed a rupture of recanalized basilar top aneurysm. Second embolization with additional coils resulted in complete occlusion. However, her neurological status was not improved afterward and she was transferred to department of rehabilitation one month after hemorrhage with comatous state. To our knowledge, this is the first case of fatal early rupture after coiling of unruptured aneurysm. It has been speculated that coiling could cause injury to aneurysmal wall and facilitate rupture.

• Journal of Korean Neurosurgical Society
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• v.41 no.5
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• pp.318-322
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• 2007

Regarding the bilateral vertebral artery [VA] dissecting aneurysms, treatment strategy remains controversial because there have not been enough cases to reach a conclusion on the best treatment. We present a patient underwent staged microsurgical trapping and endovascular coiling for each dissecting aneurysm of bilateral VA presenting subarachnoid hemorrhage [SAH]. The ruptured side was managed by VA trapping procedure without any neurological deficit. Postoperative cerebral angiography revealed patent right PICA without filling of previous right dissecting aneurysm and spontaneous occlusion of the left dissecting aneurysm one month after trapping procedure. However, follow-up angiography revealed recanalization and growing of the left VA dissecting aneurysm one year after the operation. The patient underwent endovascular embolization using GDC for the proximal occlusion of the left VA and postoperative course was uneventful.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1354-1357
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• 1992

From May 1984 through December 1991, twelve patients underwent valve replacement for infective endocarditis at National Medical Center. There were 7 male and 5 female, ranged in age 16 to 61[mean 34.1] years. Four had native valve endocarditis, six had prosthetic valve endocarditis and two were associated with congenital heart disease. The indication of surgery was medically intractable congestive heart failure in all patients. 5 patients revealed systemic embolization and 4 patients had uncontrollable sepsis. The causative organism was Streptococcus in 4 patients, Staphylococcus in 1 patient and Pseudomonas in 2 patients. Hospital mortality was 33.3%[4/12]. The main cause of death was low cardiac output due to perioperative myocardial damage and cerebral vascular accident. There were 2 late mortality because of recurrent endocarditis. This review showed much higher mortality in prosthetic valve endocarditis[66.7%] than native valve endocarditis[33.3%].

• Journal of Korean Neurosurgical Society
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• v.51 no.1
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• pp.62-65
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• 2012

Despite the remarkable developments in neurosurgical and neuro-interventional procedures, the optimal treatment for large or giant partially thrombosed aneurysms with a mass effect remains controversial. The authors report a case of a partially thrombosed aneurysm with a mass effect, which was successfully treated by stent-assisted coil embolization. A 41-year-old man presented with headache. Brain computed tomography depicted an $18{\times}18$ mm sized thrombosed aneurysm in the interpeducular cistern. More than 80% of the aneurysm volume was filled with thrombus and the canalized portion beyond its neck measured $6.8{\times}5.6$ mm by diagnostic cerebral angiography. Stent-assisted endovascular coiling was performed on the canalized sac and the aneurysm was completely obliterated. Furthermore, most of the thrombosed aneurysm disappeared in the interpeduncular cistern was clearly visualized follow-up brain magnetic resonance imaging conducted at 21 months. The authors report a case of selective coiling of a large, partially thrombosed basilar tip aneurysm.

• Journal of Korean Neurosurgical Society
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• v.53 no.4
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• pp.235-240
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• 2013

Fusiform aneurysms on the basilar artery (BA) trunk are rare. The microsurgical management of these aneurysms is difficult because of their deep location, dense collection of vital cranial nerves, and perforating arteries to the brain stem. Endovascular treatment is relatively easier and safer compared with microsurgical treatment. Selective occlusion of the aneurysmal sac with preservation of the parent artery is the endovascular treatment of choice. But, some cases, particularly giant or fusiform aneurysms, are unsuitable for selective sac occlusion. Therefore, endovascular coiling of the aneurysm with parent vessel occlusion is an alternative treatment option. In this situation, it is important to determine whether a patient can tolerate parent vessel occlusion without developing neurological deficits. We report a rare case of fusiform aneurysms in the BA trunk. An 18-year-old female suffered a headache for 2 weeks. Computed tomography and magnetic resonance image revealed a fusiform aneurysm of the lower basilar artery trunk. Digital subtraction angiography revealed a $7.1{\times}11.0$ mm-sized fusiform aneurysm located between vertebrovasilar junction and the anterior inferior cerebellar arteries. We had good clinical result using endovascular coiling of unruptured fusiform aneurysm on the lower BA trunk with parent vessel occlusion after confirming the tolerance of the patient by balloon test occlusion with induced hypotension and accompanied by neurophysiologic monitoring, transcranial Doppler and single photon emission computed tomography. In this study, we discuss the importance of preoperative meticulous studies for avoidance of delayed neurological deficit in the patient with fusiform aneurysm on lower basilar trunk.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.207-212
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• 2010

Objective : To assess the feasibility, safety, and effectiveness of the balloon-assisted technique with HyperForm balloon in the endovascular treatment of wide-necked intracranial aneurysms. Methods : A total of 34 patients with 34 wide-necked intracranial aneurysms were treated with endovascular coil embolization using balloon-assisted technique with Hyperform balloon. Twenty-nine aneurysms (85.3%) were located in the anterior circulation. The group of patients was comprised of 16 men and 18 women, aged 33 to 72 years (mean : 60.6 years). The size of aneurysms was in the range of 2.0 to 22.0 mm (mean 5.5 mm) and one of neck was 2.0 to 11.9 mm (mean 3.8 mm). The dome to neck ratio was ranged from 0.83 to 1.43 (1.15). Sixteen patients were treated for unruptured aneurysms and the remaining 18 presented with a subarachnoid hemorrhage. Results : In the 34 aneurysms treated by the remodeling technique with HyperForm balloon, immediate angiographic results consisted of total occlusion in 31 cases (91.2%) and partial occlusion in three cases (8.8%). There were five procedure-related complications (14.7%), including two coil protrusions and three thromboembolisms; Except one patient, all were successfully resolved without permanent neurologic deficit. No new bleeding occurred during the follow-up. Twenty patients (59%) underwent angiographic follow-up from 2 to 33 months (mean 9.2 months) after treatment. Focal recanalization with coil compaction of the neck portion was observed in 5 cases (25%). Only one case showed major recanalization and underwent stent-assisted coil embolization. Conclusion : The balloon-assisted technique with Hyperform balloon is a feasible, safe, and effective endovascular treatment of wide-necked cerebral aneurysms.

• Tuberculosis and Respiratory Diseases
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• v.67 no.1
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• pp.52-58
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• 2009

Pulmonary arteriovenous malformation (PAVM) is a rare pulmonary vascular anomaly due to an abnormal communication between the pulmonary artery and vein. The most common presenting symptom is a dyspnea on exertion related to this right-to-left shunt. If left untreated, PAVM has been known to result in serious complications. Incomplete pulmonary capillary network can be the cause of cerebral abscesses and other noninfectious neurological complications, such as stroke and transient ischemic attacks due to paradoxic embolism Transcatheter embolotherapy, using coils or balloons, has replaced surgical resection as the treatment of choice for PAVM. However, the risk of device embolization has limited the use of coil embolotherapy, while the size of PAVM is huge. Recently, Amplatzer$^{(R)}$ Vascular Plug has been proposed as an alternative endovascular occlusion device for arteriovenous malformation. We report a case of 81-year-old male patient with a giant PAVM, which was successfully treated by transcatheter embolotherapy using the Amplatzer$^{(R)}$ Vascular Plug.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.153-158
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• 2001

Traumatic carotid-cavernous fistula is a rare complication of moderate to severe head injury. For the treatment of carotid-cavernous fistula, detachable balloon occlusion is the best method of choice. A 26 year old male patient was hurt with a left periorbital penetrating injury 20 years ago, and then left side exophthalmos, bruit and right hemiparesis developed 10 years later. We experienced the very rare case of direct carotidcavernous fistula with cavernous dural arteriovenous fistula. Brain MRIs and cerebral angiograms revealed that direct carotid-cavernous fistula was accompanied by cavernous dural arteriovenous fistula due to longstanding venous hypertension and development of collateral circulation. Detachable balloon occlusion and surgical internal carotid artery ligation were not enough to occlude fistular flow, so cavernous dural arteriovenous fistula embolization was necessary. The authors present a case of long-standing traumatic carotid-cavernous fistula with cavernous dural arteriovenous fistula, with review of the literature.