• Journal of Preventive Medicine and Public Health
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• 제56권2호
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• pp.145-153
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• 2023

Objectives: Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume. Methods: From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression. Results: Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96). Conclusions: The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.

• Journal of Korean Neurosurgical Society
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• 제67권4호
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• pp.397-410
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• 2024

Endovascular thrombectomy (EVT) has been established as the standard of care in the treatment of acute ischemic stroke (AIS) based on landmark randomized controlled trials. Nevertheless, while the strict eligibility of EVT for AIS patients restrict the wide application of EVT, a considerable population still undergoes off-label EVT. Besides, it is important to acknowledge that recanalization is not achieved in approximately 20% of procedures, and more than 50% of patients who undergo EVT still do not experience a favorable outcome. This article reviews the brief history of EVT trials and recent progressions in the treatment of AIS, with focusing on the expanding eligibility criteria, new target for EVT, and the evolution of EVT techniques.

• Korean Journal of Radiology
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• 제20권5호
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• pp.739-748
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• 2019

For recanalization of emergent large vessel occlusions (ELVOs), endovascular therapy (EVT) using newer devices, such as a stent retriever and large-bore catheter, has shown better patient outcomes compared with intravenous recombinant tissue plasminogen activator only. Intracranial atherosclerotic stenosis (ICAS) is a major cause of acute ischemic stroke, the incidence of which is rising worldwide. Thus, it is not rare to encounter underlying ICAS during EVT procedures, particularly in Asian countries. ELVO due to underlying ICAS is often related to EVT procedure failure or complications, which can lead to poor functional recovery. However, information regarding EVT for this type of stroke is lacking because large clinical trials have been largely based on Western populations. In this review, we discuss the unique pathologic basis of ELVO with underlying ICAS, which may complicate EVT procedures. Moreover, we review EVT data for patients with ELVO due to underlying ICAS and suggest an optimal endovascular recanalization strategy based on the existing literature. Finally, we present future perspectives on this subject.

• 한국전기전자재료학회:학술대회논문집
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• 한국전기전자재료학회 2006년도 하계학술대회 논문집 Vol.7
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• pp.509-510
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• 2006

전류 및 전압을 측정하는 것은 오래전부터 CT(current transformer)/PT(potential transformer) 가 많이 사용되어져 왔지만, 이들은 iron core를 사용하기 때문에 포화특성이 발생하게 되어, 오차를 유발하게 된다. 이에 대한 대처 방안으로서 현재는 로고스키코일 및 분압방식을 이용한 ECT/EVT에 대한 적용이 진행이 되고 있다. ECT/EVT는 포화특성이 없고, 선형성이 매우우수하며, 소형, 경량이라는 점에서 현재 배전반의 변화 추세를 구현할 수 있는 충분한 능력을 지니고 있다. 이에 본 논문에서는 ECT/EVT를 제작하여, 특성을 분석하고자 한다. 특이점은 ECT/EVT가 EPOXY SPACER에 내장이 되어 사용이 되며, 이런 사용조건하에서의 이들의 특성이 변화 될 수 있는지를 살펴보았다. 그 결과 EPXOY 몰딩하에서도 그 선형성을 잃지 않았으며, 원하는 오차인 ${\pm}1%$에 부합되는 결과를 나타내었다.

• Clinical Endoscopy
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• 제56권6호
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• pp.754-760
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• 2023

Background/Aims: Endoscopic vacuum therapy (EVT) can heal a variety of defects within the gastrointestinal (GI) tract via applying negative pressure, which reduces the defect size, aspirates the infected fluid, and promotes granulation tissue. Here we present our experience with EVT as it relates to both spontaneous and iatrogenic upper GI tract perforations, leaks, and fistulas. Methods: This retrospective study was conducted at four large hospital centers. All patients who underwent EVT between June 2018 and March 2021 were included. Data on multiple variables were collected, including demographics, defect size and location, number and intervals of EVT exchanges, technical success, and hospital length of stay. Student t-test and the chi-squared test were used to analyze the data. Results: Twenty patients underwent EVT. The most common defect cause was spontaneous esophageal perforation (50%). The most common defect location was the distal esophagus (55%). The success rate was 80%. Seven patients were treated with EVT as the primary closure method. The mean number of exchanges was five with a mean interval of 4.3 days between exchanges. The mean length of hospital stay was 55.8 days. Conclusions: EVT is a safe and effective initial management option for esophageal leaks and perforations.

• Journal of Korean Neurosurgical Society
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• 제62권2호
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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.

• 재무관리연구
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• 제23권2호
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• pp.189-208
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• 2006

대부분의 국내 선행연구들은 이분산성은 GARCH모형으로, 꼬리위험은 EVT모형으로 따로 고려하였다. 이 경우 이분산성 및 꼬리의 두꺼움을 동시에 고려하지 못한 VaR값은 실제 위험량을 적절히 반영하지 못할 가능성이 있다. 따라서 본 연구에서는 이분산성 및 꼬리의 두꺼움을 고려할 수 있는 GARCH-EVT모형이 정규분포를 가정한 VaR와 이분산성을 가정한 VaR보다 높은 성과를 나타내는지 살펴보았다. 연구결과를 요약하면 다음과 같다. 첫째, 주식수익률은 정규분포보다는 꼬리부분이 두꺼운 형태를 보이고, 이분산성을 가진다. 이 경우 정규분포하에서 산출된 VaR는 실제 손실금액을 과소평가할 위험성이 있어 이분산성과 꼬리의 두꺼움을 감안할 수 있는 모형의 도입이 필요함을 알 수 있다. 둘째, 이분산성과 꼬리의 두꺼움을 고려한 GARCH-EVT모형하에서의 VaR는 정규분포를 가정한 VaR와 이분산성을 가정한 VaR보다 높은 성과를 보였다. 셋째, 이분산성 및 꼬리의 두꺼움을 고려한 GARCH-EVT모형하에서의 ES는 정규분포를 가정한 VaR와 이분산성을 가정한 VaR보다 높은 성과를 일관되게 보여주지 않았다. 결론적으로 이분산성과 꼬리의 두꺼움을 동시에 반영한 GARCH-EVT모형하에서 VaR가 금융기관의 위험관리의 유용한 도구가 될 수 있는 가능성을 발견하였다. 비록 상대적으로 높은 성과를 보이지는 않지만 ES는 VaR함께 위험척도로 같이 사용할 때 보수적인 위험관리 차원에 부합될 것이다.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.467-473
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• 2018

Objective : The aim of this study was to determine outcome of ischemic stroke patients in the anterior circulation treated with endovascular treatment (EVT) with intravenous thrombolysis (IVT) versus EVT alone group. Methods : A systemic literature review was performed using online database from January 2004 to January 2017. Primary outcomes were successful recanalization seen on finial angiography and good outcome at three months. Secondary outcomes were mortality and the development of symptomatic intracranial hemorrhage (S-ICH) after the procedure. A fixed effect model was used when heterogeneity was less than 50%. Egger's regression test was used to assess publication bias. Results : Five studies were included for final analysis. Between EVT with IVT and EVT alone group, successful recanalization (odds ratio [OR] 1.467, p=0.216), good clinical outcome at three months (OR 1.199, p=0.385), mortality (OR 0.776, p=0.371), and S-ICH (OR 1.820, p=0.280) did not differ significantly. Egger's regression intercept with 95% confidence interval (CI) was 1.99 (95% CI -2.91 to 6.89) in successful recanalization and -0.27 (95% CI -6.35 to 5.80) in good clinical outcome, respectively. Conclusion : The two treatment modalities, EVT with IVT and EVT alone, could be comparable in treating acute anterior circulation stroke. Studies to find specific beneficiary group for EVT alone, without primary IVT, are needed further.

• 전자공학회논문지SC
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• 제46권2호
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• pp.22-27
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• 2009

본 논문에서는 LCD 구동 모듈 PCB의 기능 검사를 위한 자동 검사 시스템인 EVT (Emulated Vision Tester)를 제안하고 구현하였다. 기존의 대표적인 자동검사 방법으로는 전기적 검사나 영상기반 검사방식이 있으나 전기적 검사만으로는 Timing이 주요한 변수가 되는 LCD 장비에서는 검출할 수 없는 구동불량이 존재하며 영상기반 검사는 영상획득에 일관성이 결여되거나 Gray Scale의 구분이 불명확하여 검출결과의 재현성이 떨어진다. EVT 시스템은 Pattern Generator에서 인가된 입력 패턴 신호와 구동 모듈을 통한 후 출력되는 디지털 신호를 직접 비교하여 패턴을 검사하고 아날로그 신호 (전압, 저항, 파형)의 이상 여부도 신속 정확하게 검사할 수 있는 하드웨어적인 자동 검사 방법이다. 제안된 EVT 검사기는 높은 검출 신뢰도와 빠른 처리 속도 그리고 간결한 시스템 구성으로 원가 절감 및 전공정 검사 자동화의 실현을 가능케 하는 등 많은 장점을 가진다.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.39-50
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• 2021

Objective : The treatment of large aneurysms of the posterior circulation is complicated and remains challenging. We here analyzed our institutional clinical outcomes of large unruptured aneurysms of the posterior circulation. Methods : This study included 56 patients who presented with a large (>10 mm) unruptured aneurysm of the posterior circulation between 2002 and 2018. Results : There were 18 (32.1%) male and 38 (67.9%) female patients, with a mean age of 53.4 years. The most common location was the vertebral artery, followed by the basilar tip and posterior cerebral artery. The median follow-up duration was 29 months. Eighteen patients (32.1%) were treated by transcranial surgery and 38 (67.9%) were treated by endovascular treatment (EVT). Post-treatment complications occurred in 16 patients (28.6%), with there being no significant difference between the transcranial surgery and EVT groups. Complete obliteration was achieved in 30 patients (53.6%), with there being no statistically significant difference between the transcranial surgery and EVT groups. Recurrence occurred in 17 patients (30.4%), and the rate of recurrence was higher in the EVT group than in the transcranial surgery group (39.5% vs. 11.1%, p=0.03). Forty-four (84%) of 56 patients showed a favorable functional outcome. In saccular aneurysm, EVT was negative predictor of worsening of functional status. Conclusion : Treatment of these aneurysms harbors an inherent high risk of morbidity. No superiority was found between transcranial surgery and EVT in terms of complications and complete obliteration, but transcranial surgery showed a higher treatment durability than EVT.