• Journal of Korean Neurosurgical Society
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• v.53 no.5
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• pp.274-280
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• 2013

Objective : To evaluate the feasibility and clinical and angiographic outcomes of stent-assisted embolization for complex middle cerebral artery (MCA) aneurysms. Methods : The records of 23 consecutive patients with 24 MCA aneurysms, who underwent stent-assisted embolization of the aneurysm, were retrospectively evaluated. Results : Fifteen aneurysms were treated with one stent and 8 were treated using more than two stents (5 a stent-within-a-stent, 1 triple stents, and two Y-stent). Angiographically, complete or near complete occlusion was achieved in 15 aneurysms (65.2%), residual neck in five (21.7%), and residual aneurysm in three (13.1%). Five aneurysms demonstrated thrombosis within the stent during the procedure and hospitalization, and were resolved by intraarterial and intravenous Tirofiban injection. Symptomatic thromboembolic complications were developed in five patients and permanent deficits demonstrated in two patients with modified Rankin Scale 1 and 2, respectively. Treatment-related permanent morbidity and mortality rates were 8.3% and 0% with relatively high complication rate. Angiographic follow-up was available in 17 aneurysms at 6-31 months (mean, 13.2 months) and showed stable or improved in 15 (88.2%) and major and minor recurrence in one, respectively. Conclusion : Complex MCA aneurysms could be treated by stent-assisted coiling and showed lower recanalization rate during mid-term follow-up by effective flow diversion due to various stent-assisted techniques. Our results warrant further study with a longer follow-up period in a larger sample.

• Journal of Korean Neurosurgical Society
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• v.42 no.6
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• pp.484-486
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• 2007

The authors describe a case of pseudoaneurysm arising from internal iliac artery presented with radiculopathy mimicking the symptoms of lumbar disc disease or spinal cord tumor. Among the several preoperative evaluation including CT, MRI, electrophysiologic study and ultrasonography, important diagnostic clue was obtained by ultrasonographic findings of turbulence flow at the core of partially enhanced mass in the pelvic cavity. The patient was managed with endovascular coil embolization successfully. The current case makes us remind that assessment of neurological symptoms on lower extremity should include consideration of extraspinal cause in pelvis.

• 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.

• Journal of Veterinary Clinics
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• v.28 no.2
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• pp.240-243
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• 2011

Several vascular accesses can be used for catheter guided coil embolization for occluding patent ductus arteriosus (PDA). Although trans-femoral approach is most commonly used in dogs, it is often unable to insert angiocatheter for inserting the coil delivery system, especially small puppies weighing less than 2 kg of body weight. Therefore this case study developed trans-carotid method for puppy using JR coronary catheter and free push delivery system. Using this new method, we successfully treated a puppy with PDA weighing 1.25 of body weight.

• Journal of Korean Neurosurgical Society
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• v.39 no.4
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• pp.286-291
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• 2006

Objective : We evaluate the effect of the copolymer-coated coils on immediate occlusion of the aneurysm, preventing rupture, and decreasing compaction or re-growth. Methods : Thirty-five aneurysms treated between September 2003 and December 2004 using Matrix detachable coil were reviewed. Study population consisted of 12 men and 23 women ranging in age from 34 to 75 years[mean, 55.1 years]. Twenty-two aneurysms were ruptured and 23 aneurysms were located in the anterior circulation. Follow-up angiography was obtained in 16 patients after 6 months from the procedure. Results : Initial complete occlusion was achieved in 17 aneurysms[48.6%], and the others remained as a residual neck in 8 aneurysms[22.8%] and residual sac in 10 aneurysms[28.6%]. Among these incompletely occluded aneurysms, 7 aneurysms were performed follow-up angiography. And 6 of them converted into complete occlusion. In the other hands, among 17 aneurysms achieved complete occlusion initially, 9 aneurysms were performed follow-up angiography. Recurrence due to coil compaction occurred in one aneurysm and the others maintained complete occlusion. There was one mortality case due to thromboembolic complication. Conclusion : In spite of difficulty in achieving complete occlusion with Matrix coil system, there is no rupture or re-rupture during follow-up period. Follow-up angiography shows many conversions of residual sac into complete occlusion. Embolization using Matrix coil system is safe and effective, but the effects of PGLA copolymer need further investigation.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2007.05a
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• pp.146-146
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• 2007

• Journal of Korean Neurosurgical Society
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• v.49 no.2
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• pp.134-138
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• 2011

Pediatric patients with dissecting aneurysms usually present with ischemia rather than bleeding. We report a case of a 15-year-old boy with a dissecting aneurysm of the posterior cerebral artery (PCA) presenting with hemorrhage. He was first treated with stent-assisted coil embolization, in an attempt to avoid trapping of the PCA and preserve the perforators. After the procedure, he recovered well from general anesthesia, but rebleeding occurred from the same lesion 6 hours after the procedure, therefore endovascular segmental occlusion of the parent artery was performed secondarily. Apparently, a reconstructive method of stent-assisted coiling is worth trying to preserve the parent vessel and perforators, but it is not always efficient and durable for dissecting aneurysms.

• Journal of Korean Neurosurgical Society
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• v.50 no.1
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• pp.45-47
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• 2011

Abnormal contrast enhancement on brain computed tomography (CT) scan after diagnostic or interventional angiography is not rare, and has known to be induced by temporary blood-brain barrier (BBB) disruption from contrast media. Furthermore, it has been regarded as clinically subtle, but reported to have no symptom or mild transient symptoms. However, we recently experienced two cases of serious BBB disruption during the acute period after coiling of an unruptured intracranial aneurysm. One patient presented with an unruptured paraclinoid internal carotid artery (ICA) aneurysm on the right and the other with an unruptured right supraclinoid ICA aneurysm. Both patients showed similar findings on immediate postembolization CT scan and clinical courses after coiling. Typical radiological, clinical characteristics of BBB disruption were described. In addition, the role of immediate postembolization CT scan are also discussed.

• Journal of Korean Neurosurgical Society
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• v.38 no.3
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• pp.190-195
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• 2005

Objective : This study is performed to evaluate the procedural complications, aneurysm occlusion rate, and mid-term outcome of endovascular treatments in intracranial aneurysms. Methods : We retrospectively investigated 135 patients with 161 cerebral aneurysms who were treated by endovascular means at our institute from March 1999 to December 2004. We statistically analyzed overall outcome, occlusion rate, and occurrence of complications according to the location, size, rupture history, and neck size of aneurysms. Results : Forty-nine patients [36.3%] had experienced acute intracranial or extracranial complications related to the procedure. Among these, there were 13cases of perforation of the aneurysm, 9 of local vasospasm, 8 of thromboembolism, 4 of coil migration, 3 of occlusion of parent vessels due to coil protrusion, and 1 of seizure. Extracranial complications occurred in 14cases including alopecia [9cases], femoral artery thrombosis [2cases], acute renal failure [2cases], and hypovolemic shock [1case]. One hundred twenty-six aneurysms [78.3%] had complete occlusion of the aneurysm and 35 [21.7%] incomplete occlusion at 6months angiographic follow-up. Postembolization clinical follow-up ranged from 1 to 60months [mean, 14.2months]. Seven of the 161 aneurysms underwent additional embolization and 2 incomplete embolized aneurysms required subsequent surgery. Conclusion : The procedural complications and incomplete occlusion rates are substantial. Therefore, endovascular treatment needs close and continued neurosurgical and neuroradiological concerns for the therapy of intracranial aneurysms.

• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.179-186
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• 2005

Objective: The purpose of this paper is to report our experiences in managing seventeen cases of residual intracranial aneurysms following surgical or endovascular treatment and discuss the incidence of residual aneurysms, the indications and technique of retreatment of residual aneurysms. Methods: During a period of 42 months, we treated 391 aneurysms in 339 patients with microsurgical clipping or GDC embolization as a primary treatment. In 39 of them, follow-up angiography revealed residual aneurysms and seventeen of whom were retreated. There were eleven cases in ACoA, three cases in distal ICA, one, in each of MCA, ACA and basilar artery. We reviewed retrospectively the clinical notes, operation records and cerebral angiograms of seventeen patients who had been treated for residual aneurysms. Results: Complementary treatment was performed in 8 cases by means of surgery and in 9 cases by means of GDC embolization. There were eleven females and six males with an age variation between 29 and 78 years. The mean duration of angiographic follow-up was 17.3 months. Of the seventeen cases that were treated for residual aneurysms, fourteen achieved complete occlusion. Of 17 retreated patients, fifteen patients had good recovery according to the Glasgow Outcome Scale. Conclusion: When occlusion after endovascular or surgical treatment is incomplete, a new multidisciplinary approach should be carried out. Given our experiences, we recommend coil embolization of the choice in cases that the residual aneurysmal neck had been narrowed by previous clipping. On the other hand, if the residual aneurysm has enough space to clip but not enough to coil, we recommend the microsurgical clipping.