• 제목/요약/키워드: Coronary stent

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Acute Limb Ischemia and Coronary Artery Disease in a Case of Kimura's Disease

  • Heo, Woon;Jun, Hee Jae;Kang, Do Kyun;Min, Ho-Ki;Hwang, Youn-Ho;Kim, Ji Yong;Nam, Kyung Han
    • Journal of Chest Surgery
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    • 제50권2호
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    • pp.114-118
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    • 2017
  • Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion. KD is a systemic disease that affects many organs and presents with thromboembolism and vasculitis. In a patient with KD, physicians should evaluate the vascular system, including the coronary arteries.

Clopidogrel에 Proton Pump Inhibitors 병용 시 급성 관동맥 증후군 환자의 심장관련 부작용에 미치는 영향 (Influence of the Concomitant Use of Clopidogrel and Proton Pump Inhibitors on Adverse Cardiovascular Events in Korean Patients with Acute Coronary Syndrome)

  • 김수현;이유정
    • 한국임상약학회지
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    • 제24권2호
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    • pp.106-114
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    • 2014
  • Purpose: Recent investigations suggest that the antiplatelet effect of clopidogrel may be decreased when this medication is taken together with certain proton pump inhibitors (PPIs). However, there has been no study conducted in Korea regarding the clinical effect of clopidogrel-PPI interaction. This study targeted patients who received stents to investigate the effect of the concomitant use of clopidogrel and PPIs on the occurrence of adverse cardiovascular events in Korean patients. Methods: The patients who received a stent insertion at the Yeouido St. Mary's Hospital between January 2010 and April 2011 were included. The patients were divided into two groups, clopidogrel and clopidogrel + PPI, and followed for 12 months after the date of stent insertion using prescription history and medical records. The recurrence rates of the cardiovascular events among the two patient groups were statistically analyzed. Results: There was no difference between the two groups in the basic characteristics of the 157 patients in the clopidogrel group and the 62 patients in the clopidogrel+PPI group. Simple logistic regression showed a significantly higher rate of re-hospitalization in the clopidogrel+PPI group (OR=1.893, 95% CI 1.040-3.445, p=0.037). However, the results of the multivariate logistic regression of the variables found to have statistical significance by crosstabulation showed no significant difference in the rate of adverse cardiovascular events or re-hospitalization between the two groups. Conclusions: There was no significant difference between the clopidogrel and clopidogrel+PPI group among new patients with cardiovascular stents with respect to the occurrence of revascularization procedures, stent thrombosis, or chest pain, or with respect to the re-hospitalization rate for all cardiovascular events.

관동맥혈관 내 방사선 근접 치료 (Intracoronary Radiation Therapy)

  • 문대혁;박성욱;홍명기;오승준;범희승;이희경
    • 대한핵의학회:학술대회논문집
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    • 대한핵의학회 2001년도 제40차 춘계학술대회 및 연수교육
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    • pp.24-34
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    • 2001
  • Restenosis remains a major limitation of percutaneous coronary interventions. Numerous studios including pharmacological approaches and new devices failed to reduce the restenosis rate except coronary stenting. Since the results of $BENESTENT^{1)}\;and\;STRESS^{2)}$ studies came out, coronary stenting has been the most popular interventional strategy in the various kinds of coronary stenotic lesions, although the efficacy of stenting was shown only in the discrete lesion of the large coronary artery. The widespread use of coronary stenting has improved the early and late outcomes after coronary intervention, but it has also led to a new and serious problem, e.g., in-stent restenosis. Intravascular radiation for prevention of restenosis is a new technology in the field of percutaneous coronary intervention. Recent animal experiments and human trials have demonstrated that local irradiation, in conjunction with coronary interventions, substantially diminished the rate of restenosis. This paper reviews basic radiation biology of intracoronary radiation and its role in the inhibition of restenosis. The current status of intracoronary radiation therapy using Re-188 liquid balloon is also discussed.

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약물용출 스텐트를 이용한 관상동맥중재술 후 재협착의 독립적 예측인자에 관한 연구 : MDCT calcium-scoring 시행 환자 대상으로 (The Study on the Independent Predictive Factor of Restenosis after Percutaneous Coronary Intervention used Drug-Eluting Stent : Case on MDCT Calcium-Scoring Implementation Patient)

  • 김인수;한재복;장성주;장영일
    • 대한방사선기술학회지:방사선기술과학
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    • 제33권1호
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    • pp.37-44
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    • 2010
  • 본 연구에서는 약물용출성 스텐트 삽입 후 재협착에 관한 독립적 인자를 확인하고 MDCT로 측정된 calcium score가 재협착 발생의 예측인자로써 가능성을 알아보고자 하였다. 2006년 5월부터 2009년 5월까지 전남대학교병원에서 MDCT상 관상동맥 협착이 발견되어 약물 용출 스텐트를 삽입 받은 환자 1,131명 중 추적검사로 관상동맥조영술을 시행되었던 178명(남자 159명, 여자 19명, 평균 연령 61.7, 연령분포 51~71세), 190개소 병변을 대상으로 하였으며 재협착 여부에 따라 두 군(비협착군 133병변, 재협착군 57병변)으로 나누어 비교 분석하였다. 그 결과 임상진단명은 진구성 심근경색이 비협착군 3예(2.3%), 재협착군 5예(8.8%)로 유의한 차이가 있었으며(p = 0.040), 급성 심근경색증, 불안정 협심증, 안정 협심증의 유병률은 차이가 없었다. 관상동맥 조영술 소견에서 병변 혈관의 위치는 재협착군에서 좌주간지 병변이 더 많았다(0.8% vs. 5.3%, p = 0.047). 스텐트 직경은 재협착군에서 유의하게 작았으며($3.3{\pm}0.4\;mm$ vs. $3.1{\pm}0.3\;mm$, p = 0.004), 스텐트 길이는 양군 간에 차이가 없었다. 관상동맥 조영술 상 혈관의 초기 협착 정도는 재협착군에서 더 심했으며($86.1{\pm}11.4%$ vs. $91.5{\pm}9.2%$, p = 0.001), 복잡 병변(B2/C형)은 양 군간에 차이가 없었다. 연령은 재협착군에서 더 높았고($60.2{\pm}9.9$세 vs. $65.8{\pm}9.0$세, p = 0.0001), 흡연력과 고지혈증은 비협착군에서(42.1% vs. 19.3%, p = 0.003, 23.3% vs. 8.8%, p = 0.019), 그리고 당뇨병은 재협착군에서 많았다(21.8% vs. 52.6%, p = 0.0001). 심초음파로 측정한 좌심실 구혈률은 양 군 간에 유의한 차이는 없었다. 전체 MDCT coronary artery calcium scoring는 비협착군 $371.2{\pm}500.8$, 재협착군 $389.3{\pm}458.3$로 차이가 없었고, 목표혈관과 좌주간지, 좌전하행지, 좌회선지 및 우관상동맥 각각의 calcium score 역시 양군 간 차이가 없었다. 다 변량 로지스틱 회귀분석에서 좌주간지 병변(OR = 168.0, 95% CI = 7.83-3,604.3, p = 0.001), 남성(OR = 36.5, 95% CI = 5.89-2,226.9, p = 0.0001), 당뇨병의 존재(OR = 2.62, 95% CI = 1.071~6.450, p = 0.035)가 약물용출성 스텐트 삽입 후 재협착 발생에 대한 독립적인 예측인자이었다. 따라서 관상동맥 협착에 대해 약물용출 스텐트를 삽입 받은 환자에서 스텐트 내 재협착의 발생은 좌주간지 병변, 남성, 당뇨병의 존재와 관련이 있었으나, MDCT로 측정된 calcium score는 재협착 발생에 대한 독립적인 예측인자로써 기능은 없었다.

Association of Clusterin Polymorphisms with Coronary Heart Disease in Koreans

  • ;;;유민
    • 대한의생명과학회지
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    • 제14권1호
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    • pp.55-58
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    • 2008
  • Clusterin is an 80 kDa heterodimetric glycosylated protein and it plays diverse biological roles in various tissues and organs. Clusterin is reported to be associated with the pathogenesis of coronary artery disease and atherosclerosis. Therefore, we investigated the genotype for the A/G polymorphism at the position 4,183 of clusterin gene in Koreans and compared genotype of patients with control group. 100 patients (Male 63, Female 37), who previously underwent coronary artery stent due to ischemic heart disease and 100 controls (Male 36, Female 64) participated in this study. There was a significant association between 4,183 A/G polymorphism in clusterin gene and coronary artery disease (CAD). The present study shows that clusterin gene A/G polymorphism may be associated with the pathogenesis of CAD. Further studies with larger population may be needed for the development of diagnostic methods at genetic level such as DNA chip.

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유한요소 해석을 이용한 스텐트 최적형상 설계 (A Study on Optimal Shape of Stent by Finite Element Analysis)

  • 이태현;양철호
    • 한국산학기술학회논문지
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    • 제18권11호
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    • pp.1-6
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    • 2017
  • 스텐트는 인체의 좁아지거나 막힌 부위에 삽입되어 혈류의 흐름을 정상화 시키는데 사용되는 금속망 형태의 임플란트로 관상 동맥 질환을 치료하는데 가장 일반적인 방법으로 널리 사용된다. 본 논문에서는 유한요소 해석과 다꾸지 방법을 이용하여 설정한 스텐트 설계 인자의 변화에 따른 기계적 반응을 고찰하였다. 스텐트 모델은 팔마즈 스텐트를 사용하였고 스텐트의 재료 모델로서는 탄소성 모델, 풍선은 초탄성 모델을 사용하였다. 연구의주요 관심은 스텐트의 탄성 회복량 조절을 통한 혈관의 재 협착 문제를 감소시킬 수 있는 방안에 대한 설계 인자의 영향을 고찰하는데 있다. 스텐트 두께, 슬롯의 가로 길이, 슬롯의 세로 길이의 각도를 설계인자로 선택하여 직교배열표를 구성하였다. 유한요소 해석을 이용하여 혈관 내 스텐트의 반경 방향 탄성회복율과 길이 방향 탄성회복율을 계산하였고 다구찌 기법을 이용한 통계적 분석을 하여 재 협착의 가능성을 감소시킬 수 있는 스텐트의 최적 형상 설계 방향을 제시하였다. 최적형상은 기본 모델에 비하여 탄성회복율은 반경방향으로 약 1%, 길이방향으로 약 0.1% 감소함을 보였다.

심근관류 SPECT와 64채널 전산화 단층혈관 촬영 사진 융합으로 증명된 radius intermedius 협착에 의한 심근관류 저하 (Radius Intermedius Stenosis Induced Myocardial Perfusion Defect: Provened by the Fusion Images of Myocardial Perfusion SPECT and 64 Channel CTA)

  • 공은정;조인호;천경아;원규장;이형우;박종선
    • Nuclear Medicine and Molecular Imaging
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    • 제42권1호
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    • pp.77-78
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    • 2008
  • A 71-year-old woman was assigned to our department for Tc-99m myocardial perfusion SPECT(MPS) and coronary CT angiography. She admitted for substernal pain, via the ER, 2 days ago. The heart was scanned after intravenous injection of 925 MBq of $^{99m}Tc$-sestamibi adenosine-induced stress SPECT using dual head gamma camera (Hawkeye, GE healthcare. USA). The MPS shows decreased tracer uptake in the apical & mid area of anterior & lateral wall and mid & basal inferior wall. Coronary CT angiograph was obtained using Discovery VCT (GE healthcare). 3D angiography portrayed significant stenosis of ramus intermedius(RI) and posterolateral branch of right coronary artery(PLB) with fibrocalcified plaque. Two images were fused using Cardiac IQ fusion softwear package (Advantage workstation 4.4, GE healthcare) The fusion images explain the perfusion defect of anterior, lateral and inferior wall is due to stenosis of the RI and PLB. And 3 days later, coronary angiography was done and revealed the marked stenosis of RI and PLB. Then balloon angioplasty and stent was instituted in RI. Cardiac SPECT/CT fusion imaging provides additional information about hemodynamic relevance and facilitates lesion interpretation by allowing exact allocation of perfusion defects to its subtending coronary artery.

Thermal Process for Enhancing Mechanical Strength of PLGA Nanoparticle Layers on Coronary Stents

  • Joo, Jae-Ryang;Nam, Hye-Yeong;Nam, So-Hee;Baek, In-Su;Park, Jong-Sang
    • Bulletin of the Korean Chemical Society
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    • 제30권9호
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    • pp.1985-1988
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    • 2009
  • Poly (lactic-co-glycolic acid) (PLGA) nanoparticles loading paclitaxel have been deposited on coronary stents by self-assembling properties of colloidal particles. The layers of the nanoparticles were enhanced to a sufficient mechanical strength by a thermal process under the proper temperature and humidity conditions. In vitro release studies proved the controlled paclitaxel release of the nanoparticle layers. This technique gives rise to a new range of applications for nanoparticles and drug-eluting stents.

Urgent Recanalization with Stenting for Severe Intracranial Atherosclerosis after Transient Ischemic Attack or Minor Stroke

  • Park, Tae-Sik;Choi, Beom-Jin;Lee, Tae-Hong;Song, Joon-Suk;Lee, Dong-Youl;Sung, Sang-Min
    • Journal of Korean Neurosurgical Society
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    • 제50권4호
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    • pp.322-326
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    • 2011
  • Objective : Stenting of symptomatic intracranial stenosis has recently become an alternative treatment modality. However, urgent intracranial stenting in patients with intracranial stenosis following a transient ischemic attack (TIA) or minor stroke is open to dispute. We sought to assess the feasibility, safety, and effectiveness of urgent intracranial stenting for severe stenosis (>70%) in TIA or minor stroke patients. Methods : Between June 2009 and October 2010, stent-assisted angioplasty by using a balloon-expandable coronary stent for intracranial severe stenosis (>70%) was performed in 7 patients after TIA and 5 patients after minor stroke (14 stenotic lesions). Technical success rates, complications, angiographic findings, and clinical outcomes were retrospectively analyzed. Results : Stenting was successful in all 12 patients. The mean time from symptom onset to stenting was 2.1 days (1-8 days). Post-procedural angiography showed restoration to a normal luminal diameter in all patients. In-stent thrombosis occurred in one patient (n=1, 8.3%), and was lysed with abciximab. No device-related complications, such as perforations or dissections at the target arteries or intracranial hemorrhaging, occurred in any patient. The mortality rate was 0%. No patient had an ischemic event over the mean follow-up period of 12.5 months (range, 7-21 months), and follow-up angiography (n=7) revealed no significant in-stent restenosis (>50%). Conclusion : Urgent recanalization with stenting is feasible, safe, and effective in patients with TIA or acute minor stroke with intracranial stenosis of ${\geq}$ 70%.