• Journal of Korean Neurosurgical Society
• /
• 제57권1호
• /
• pp.12-18
• /
• 2015

Objective : Covered stent has been recently reported as an effective alternative treatment for direct carotid cavernous fistulas (DCCFs). The purpose of this study is to describe our experiences with the treatment of DCCF with covered stents and to evaluate whether a covered stent has a potential to be used as the first choice in selected cases. Methods : From February 2009 through July 2013, 10 patients underwent covered stent placement for a DCCF occlusion. Clinical and angiographic data were retrospectively reviewed. Results : Covered stent placement was performed for five patients primarily as the first choice and in the other five as an alternative option. Access and deployment of a covered stent was successful in all patients (100%) and total occlusion of the fistula was achieved in nine (90%). Complete occlusion immediately after the procedure was obtained in five patients (50%). Endoleak persisted in five patients and the fistulae were found to be completely occluded by one month control angiography in four. The other patient underwent additional coil embolization by a transvenous approach. Balloon inflation-related arterial dissection during the procedure was noted in two cases; healing was noted at follow-up angiography. One patient suffered an asymptomatic internal carotid artery occlusion noted seven months post-treatment. Conclusion : Although endoleak is currently a common roadblock, our experience demonstrates that a covered stent has the potential to be used as the first choice in DCCF; this potential is likely to increase as experience with this device accumulates and the materials continue to improve.

• Journal of Korean Neurosurgical Society
• /
• 제62권2호
• /
• pp.201-208
• /
• 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.

• 대한영상의학회지
• /
• 제82권6호
• /
• pp.1628-1633
• /
• 2021

척수 경막외 동정맥루는 매우 드문 질환으로 진단과 치료가 어렵다. 무증상 환자도 있으나 동정맥단락으로 척수주위정맥으로 역류되고 늘어난 정맥이 인접한 신경근을 압박하면서 증상이 생길 수 있다. 본 증례는 31세 남자 환자로 2년 동안 지속되는 요통, 방사성 허벅지통증, 하지 감각변화로 내원하였다. 컴퓨터단층촬영, 자가공명장치 및 척수혈관조영술에서 요추의 경막외 공간에서 동정맥단락에 의해 늘어난 정맥이 신경근을 압박하고 있는 척수 경막외 동정맥루로 진단하였다. 코일색전술을 시행하여 동정맥단락을 차단하였고 수일 내에 신경근 압박증상이 호전되었다. 이번 증례에서는 척수 경막외 동정맥루에서 외과적 수술의 대안으로 코일 색전술이 효과적인 치료가 될 수 있다는 것을 보여주었다.

• 대한영상의학회지
• /
• 제85권1호
• /
• pp.235-239
• /
• 2024

장골동맥-장골정맥루는 드문 질환으로 일으키는 주요 요인으로는 선천성 이상 발생, 의인성, 외상 등이 있다. 그중에서도 May-Thurner 증후군과 동반된 장골동맥-장골정맥루에 대한 문헌은 매우 드물다. 이에 따라, 저자들은 80세 남성에서 발생한 May-Thurner 증후군과 동반된 장골동맥-장골정맥루의 증례를 보고하고자 한다. 컴퓨터단층촬영 및 혈관조영술을 통해 매우 넓은 범위의 장골동맥-장골정맥루를 확인하였고 이에 대해 다양한 크기의 색전용 코일 및 1400-2000 ㎛ 크기의 젤라틴 입자를 사용하여 색전술을 시행하였다. 색전술 이후, 추적을 위해 시행한 복부-골반 컴퓨터단층촬영에서 왼쪽 다리의 부종이 개선됨을 확인하였다.

• Journal of Korean Neurosurgical Society
• /
• 제61권2호
• /
• pp.201-211
• /
• 2018

Objective : The purpose of this study was to analyze the variability of clopidogrel responses according to duration of a clopidogrel drug regimen after stent-assisted coil embolization (SAC), and to determine the correlation between the variability of clopidogrel responses and thromboembolic or hemorrhagic complications. Methods : A total of 47 patients who underwent SAC procedures to treat unruptured intracranial aneurysms were enrolled in the study. Preoperatively, patients received more than seven days of aspirin (100 mg) and clopidogrel (75 mg), daily. P2Y12 reaction unit (PRU) was checked with the VerifyNow test one day before the procedure (pre-PRU) and one month after the procedure (post-PRU). PRU variability was calculated as the difference between the initial response and the follow-up response. Patients were sorted into two groups based on their response to treatment : responsive and hypo-responsive. Results : PRU variability was significantly greater in the hypo-responsive group when compared to the responsive group (p=0.019). Pre-PRU and serum platelets counts were significantly correlated with PRU variation (p=0.005 and p=0.004, respectively). Although thromboembolic complication had no significant correlated factors, hemorrhagic complication was correlated with pre-PRU (p=0.033). Conclusion : In conclusion, variability of clopidogrel responses during clopidogrel medication was correlated to serum platelet counts and the initial clopidogrel response. Thromboembolic and hemorrhagic complications did not show correlation with the variability of clopidogrel response, or the clopidogrel response after one month of medication; however, hemorrhagic complication was associated with initial clopidogrel response. Therefore, it is recommended to test patients for an initial clopidogrel response only, as further tests would be insignificant.

• Tuberculosis and Respiratory Diseases
• /
• 제67권1호
• /
• pp.52-58
• /
• 2009

폐동정맥기형은 드문 폐혈관 질환으로 출혈, 뇌농양, 기이 색전증(paradoxical embolism)에 의한 여러 신경학적 합병증의 발생 위험을 증가시켜 치료를 요한다. 과거에는 수술적으로 제거했으나, 최근에는 주로 코일 및 풍선 등의 다양한 색전물질을 이용한 경피적 색전술을 시행하여 치료하는 추세이다. 거대 폐동정맥기형의 경우에는 색전술 시행 과정에서 코일이 전신 순환으로 빠져 나가 장치 색전증 등의 합병증을 일으킬 위험이 높다. 저자들은 호흡곤란을 주소로 내원한 81세 남자 환자에게서, 지속되는 저산소혈증의 원인으로 거대 폐동정맥기형을 진단하고, Amplatzer$^{(R)}$ 혈관폐색장치를 이용한 경피적 색전술로 치료한 1예를 경험하였기에, 문헌 고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
• /
• 제55권4호
• /
• pp.185-189
• /
• 2014

Objective : General anesthesia is often preferred for endovascular coiling of intracranial aneurysm at most centers. But in the authors' hospital, it is performed under monitored anesthesia care (MAC) using dexmedetomidine. To determine the feasibility and safety of this approach, the authors reviewed our initial experience. Methods : Retrospective data was analyzed from July 2012 to November 2012. We performed coil embolization in 28 cases using this method. Among them, for statistical significance, we analyzed 12 cases in which the procedure time exceeded an hour. Vital signs were analyzed every 10 minutes. Depth of sedation was measured according to the Ramsay sedation scale and frequency of the repeated roadmap image(s) caused by movement of the patient's head during the procedure. Results : All procedures were completed without occurrence of procedure related complications. Under MAC using dexmedetomidine, vital signs of the patients were stable, no statistical significance regarding hemodynamic and respiratory parameters was observed between time points (p>0.05). Adequate sedation was achieved. Mean Ramsay sedation scale was $3.67{\pm}1.61$ (2 to 6). Repeated roadmap image(s) due to patient's factor occurred in only one case. The mean dosage of drug for adequate sedation for the procedure was $0.65{\pm}0.12mcg/kg/hr$ without loading doses. Conclusion : To the best of my knowledge, this is the first report published in English using the method of monitored anesthesia with dexmedetomidine for intracranial aneurysm coiling. Monitored anesthesia care using dexmedetomidine without loading dose for embolization of intracranial aneurysms appeared to be a safe and effective alternative to general anesthesia.

• Journal of Yeungnam Medical Science
• /
• 제36권3호
• /
• pp.208-218
• /
• 2019

Background: The anatomy of middle cerebral artery (MCA) aneurysms has been noted to be unfavorable for endovascular treatment. The purpose of this study was to assess the feasibility and efficacy of coiling for MCA aneurysms. Methods: From January 2004 to December 2015, 72 MCA aneurysms (38 unruptured and 34 ruptured) in 67 patients were treated with coils. Treatment-related complications, clinical outcomes, and immediate and follow-up angiographic outcomes were retrospectively analyzed. Results: Aneurysms were located at the MCA bifurcation (n=60), 1st segment (M1, n=8), and 2nd segment (M2, n=4). Sixty-nine aneurysms (95.8%) were treated by neck remodeling techniques using multi-catheter (n=44), balloon (n=14), stent (n=8), or combination of these (n=3). Only 3 aneurysms were treated by single-catheter technique. Angiographic results were 66 (91.7%) complete, 5 (6.9%) remnant neck, and 1 (1.4%) incomplete occlusion. Procedural complications included aneurysm rupture (n=1), asymptomatic coil migration to the distal vessel (n=1), and acute thromboembolism (n=10) consisting of 8 asymptomatic and 2 symptomatic events. Treatment-related permanent morbidity and mortality rates were 4.5% and 3.0%, respectively. There was no bleeding on clinical follow-up (mean, 29 months; range, 6-108 months). Follow-up angiographic results (mean, 26 months; range, 6-96 months) in patients included 1 major and 3 minor recanalizations. Conclusion: Coiling of MCA aneurysms could be a technically feasible and clinically effective treatment strategy with acceptable angiographic and clinical outcomes. However, the safety and efficacy of this technique as compared to surgical clipping remains to be ascertained.

• 대한영상의학회지
• /
• 제81권5호
• /
• pp.1216-1221
• /
• 2020

국소진행성 췌장암 환자에서 이차적 근치절제 가능성을 얻기 위해 수술 전 동시항암화학방사선요법이 점차 많이 이용되고 있다. 대부분의 환자들에게 담도의 감압이 필요함에도 불구하고, 담도 스텐트와 동시항암화학방사선요법을 함께 시행하는 안전성에 대한 연구는 많지 않다. 저자들은 동시항암화학방사선요법 후 담도 스텐트에 의해 발생한 지연성 간동맥 출혈의 드문 증례를 보고하는 바이다. 추적 관찰 CT에서 담도 스텐트와 우간동맥과의 거리가 점점 가까워졌고, 결국 스텐트가 간동맥을 압박하여 간동맥에 심한 굴곡이 생겼다. 카테터 혈관조영술에서 우간동맥에 조영제의 혈관 외 유출이 발견되어 혈관 내 색전술을 이용하여 치료하였다. 본 증례 보고는 동시항암화학방사선요법 후 발생하는 해부학적 변형이 심각한 합병증의 원인이 될 수도 있음을 강조하고 있다. 간동맥이 담도 스텐트에 의해 압박되는 소견은 혈관손상의 경고 신호로서 주의가 필요하다.

• Journal of Korean Neurosurgical Society
• /
• 제60권6호
• /
• pp.644-653
• /
• 2017

Objective : Paraclinoid aneurysms are a group of aneurysms arising at the distal internal carotid artery. Due to a high incidence of small, wide-necked aneurysms in this zone, it is often challenging to achieve complete occlusion when solely using detachable coils, thus stent placement is often required. In the present study, we aimed to investigate the effect of stent placement in endovascular treatment of paraclinoid aneurysms. Methods : Data of 98 paraclinoid aneurysms treated by endovascular approach in our center from August 2005 to June 2016 were retrospectively reviewed. They were divided into two groups : simple coiling and stent-assisted coiling. Differences in the recurrence and progressive occlusion between the two groups were mainly analyzed. The recurrence was defined as more than one grade worsening according to Raymond-Roy Classification or major recanalization that is large enough to permit retreatment in the follow-up study compared to the immediate post-operative results. Results : Complete occlusion was achieved immediately after endovascular treatment in eight out of 37 patients (21.6%) in the stent-assisted group and 18 out of 61 (29.5%) in the simple coiling group. In the follow-up imaging studies, the recurrence rate was lower in the stent-assisted group (one out of 37, 2.7%) compared to the simple coiling group (13 out of 61, 21.3%) (p=0.011). Multivariate logistic regression model showed lower recurrence rate in the stent-assisted group than the simple coiling group (odds ratio [OR] 0.051, 95% confidence interval [CI] 0.005-0.527). Furthermore there was also a significant difference in the rate of progressive occlusion between the stent-assisted group (16 out of 29 patients, 55.2%) and the simple coiling group (10 out of 43 patients, 23.3%) (p=0.006). The stent-assisted group also exhibited a higher rate of progressive occlusion than the simple coiling group in the multivariate logistic regression model (OR 3.208, 95% CI 1.106-9.302). Conclusion : Use of stents results in good prognosis not only by reducing the recurrence rate but also by increasing the rate of progressive occlusion in wide-necked paraclinoid aneurysms. Stent-assisted coil embolization can be an important treatment strategy for paraclinoid aneurysms when considering the superiority of long term outcome.