• Journal of Korean Neurosurgical Society
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• 제66권2호
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• pp.144-154
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• 2023

Objective : Stroke caused from large vessel occlusion (LVO) has emerged as the most common stroke subtype worldwide. Intravenous tissue plasminogen activator administration (IV-tPA) and additional intraarterial thrombectomy (IA-Tx) is regarded as standard treatment. In this study, the authors try to find the early recanalization rate of IV-tPA in LVO stroke patients. Methods : Total 300 patients undertook IA-Tx with confirmed anterior circulation LVO, were analyzed retrospectively. Brain computed tomography angiography (CTA) was the initial imaging study and acute stroke magnetic resonance angiography (MRA) followed after finished IV-tPA. Early recanalization rate was evaluated by acute stroke MRA within 2 hours after the IV-tPA. In 167 patients undertook IV-tPA only and 133 non-recanalized patients by IV-tPA, additional IA-Tx tried (IV-tPA + IA-Tx group). And 131 patients, non-recanalized by IV-tPA (IV-tPA group) additional IA-Tx recommend and tried according to the patient condition and compliance. Results : Early recanalization rate of LVO after IV-tPA was 12.0% (36/300). In recanalized patients, favorable outcome (modified Rankin Scale, 0-2) was 69.4% (25/36) while it was 32.1% (42/131, p<0.001) in non-recanalized patients. Among 133 patients, non-recanalized after intravenous recombinant tissue plasminogen activator and undertook additional IA-Tx, the clinical outcome was better than not undertaken additional IA-Tx (favorable outcome was 42.9% vs. 32.1%, p=0.046). Analysis according to the perfusion/diffusion (P/D)-mismatching or not, in patient with IV-tPA with IA-Tx (133 patients), favorable outcome was higher in P/D-mismatching patient (52/104; 50.0%) than P/D-matching patients (5/29; 17.2%; p=0.001). Which treatment tired, P/D-mismatching was favored in clinical outcome (iv-tPA only, p=0.008 and IV-tPA with IA-Tx, p=0.001). Conclusion : The P/D-mismatching influences on the recanalization and clinical outcomes of IV-tPA and IA-Tx. The authors would like to propose that we had better prepare IA-Tx when LVO is diagnosed on initial diagnostic imaging. Furthermore, if the patient shows P/D-mismatching on MRA after IV-tPA, additional IA-Tx improves treatment results and lessen the futile recanalization.

• 전자공학회논문지
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• 제53권6호
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• pp.137-145
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• 2016

본 논문에서는 새로운 방법의 3차원 컴퓨터단층영상에서 혈관을 추적하는 알고리즘을 소개하고자 한다. 해당 방법은 먼저 빠르게 다수의 2차 혹은 3차의 정칙곡선들로 대표되는 혈관의 지역적 모델들을 생성한다. 혈관의 특징을 고려한 비용함수로부터 각 곡선들은 영상데이터를 기반으로 생성된 비용을 부여 받는다. 추적 과정에서 매 단계 다음 혈관을 추정하기 위한 곡선들은 특정 기준에 의하여 여과되어 결국 혈관의 내부에 위치한 곡선들만 걸러낸다. 그 후 이들을 기반으로 혈관의 중심 선에 해당하는 최적의 정칙곡선 하나를 선정하게 된다. 지역적으로 최적인 정칙곡선이 순차적으로 검출되며 이들을 연결하여 하나의 혈관을 대표하는 구분적으로 부드러운 곡선을 만들어낸다. 짧은 정칙곡선은 제어 점들만으로 빠르게 기하학적 변환이 가능하며, 정의역 모든 구간에 대하여 미분이 가능하므로 곡률과 비틀림과 같은 기하학적 정보를 얻기 용이한 장점이 있다. 해당 방법에서 사용되는 정칙곡선모델이 혈관을 분류하고 추적함에 있어서 그 적합성을 증명하였고, 공공 데이터를 이용한 실험을 통하여 정확성과 수행 시간에 대해 최신기법들과 비교할만한 결과를 얻었다.