• 대한방사선기술학회지:방사선기술과학
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• 제31권3호
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• pp.267-276
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• 2008

본 연구는 20세에서 50세까지 건강한 남성 지원자를 대상으로 내경동맥과 내경정맥의 혈류속도를 측정하기 위하여 2D-PC MRA를 촬영했다. 2D-PC MRA는 제4-5경추디스크를 지나는 FOV 24cm 넓이로 횡단 촬영하여 내경동맥과 내경정맥의 혈류속도를 넥타이를 매지 않은 상태와 세게 맨 상태에서 각각 측정하였다. 넥타이를 매지 않았을 때 내경동맥의 평균 혈류속도 최고치는 우측 72.13cm/sec, 좌측 74.96cm/sec (양측 평균 73.54cm/sec)이였고 내경정맥의 평균 혈류속도 최고치는 우측 -34.45cm/sec, 좌측 -24.99cm/sec(양측평균 -29.72cm/sec)였다. 그러나 넥타이를 세게 매었을 때 내경동맥의 평균 혈류속도 최고치는 우측 61.35cm/sec, 좌측 65.19cm/sec(양측 평균 63.27cm/sec)이며 내경정맥의 혈류속도 최고치는 우측 -22.14cm/sec, 좌측 -17.93cm/sec (양측 평균 20.03cm/sec)였다. 목에 세게 넥타이를 맨 경우가 넥타이를 매지 않은 상태 보다 양쪽 내경동맥의 평균 혈류속도가 86% (63.27/73.54cm/sec)로 약간 감소하는 반면 양쪽 내경정맥의 평균 혈류속도는 67%(-20.03/-29.72cm/sec)로 유의성 있게 감소하였다(P<0.05). 따라서 넥타이를 세게 매었을 때 내경정맥의 순환에 미치는 영향(33%의 혈류속도감소)이 내경동맥(14%의 혈류속도감소) 보다 유의성 있게 큰 것을 알 수 있었다(P<0.05). 결론적으로 본 연구결과는 2D-PC MRA를 이용하여 넥타이를 목에 세게 매었을 때 순간적으로 양쪽 내경정맥이 내경동맥보다 상대적으로 압박되어 혈류속도가 의미 있게 감소되며 일시적 폐쇄가 되는 소견을 보였다. 이 경우 넥타이를 목에 세게 매고 생활을 하는 경우에 대변을 보거나 또는 세면을 하는 등 일상적인 생활에서도 예기치 않게 일시적으로 내경정맥혈관이 압박되어 폐쇄되며 이차적으로 두개강 내의 정맥성고혈압을 일으켜 뇌졸중의 요인이 될 수 있는 것으로 유추된다.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.428-432
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• 2010

Objective : An effective intervention has not yet been established for patients with acute occlusion of the internal carotid artery (ICA). The aim of our study was to investigate the feasibility, safety, and efficacy of emergent stent placement of carotid artery to improve neurologic symptoms and clinical outcome. Methods : Of 84 consecutive patients with severe ICA stenosis who were admitted to our institution from March 2006 to May 2009, 10 patients with acute ICA occlusion (11.9%) underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome using the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome using the modified Rankin Scale score (mRS) and Glasgow Outcome Scale (GOS); frequency of procedure-related complications; and recurrence rate of ipsilateral ischemic stroke within 90 days. Results : Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 16.6 and 6, respectively, showing significant improvement. Eight patients (80%) had favorable outcomes (mRS score 0-2 and GOS 4-5). Complications occurred in two patients (20%): stent insertion failed in one and an intracerebral hemorrhage occurred in the other. Ipsilateral ischemic stroke did not recur within 3 months. Conclusion : Emergency carotid artery stent placement can improve the 7-day neurologic outcome and the 90-day clinical outcome in selected patients with acute cerebral infarction.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.190-194
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• 2015

Blunt cerebrovascular injury is defined as a vertebral or carotid arterial structural wall injury resulting from nonpenetrating trauma. Complete traumatic internal carotid artery occlusion is very rare condition accounting for 0.08~0.4 0f all trauma patients and believed to be associated with the greatest risk of ischemic stroke reported in 50~90% in a few small series. A 55-year-male was admitted with drowsy mentality and severe headache after a fall down accident. Brain computed tomography showed a subdural hematoma at the both frontal area with a fracture of the occipital skull bone. Two days after admission, he suddenly complained with a right side hemiparesis of motor grade 2. Brain magnetic resonance diffusion demonstrated multiple high flow signal changes from the left frontal and parietal lesion. Computed tomographic angiogram (CTA) revealed absence of the left ICA flow. Trans femoral cerebral angiography (TFCA) showed complete occlusion of the left internal carotid artery (ICA) at ophthalmic segment in the left ICA angiogram and flows on the left whole hemispheric lesions through the anterior communicating artery in the right ICA angiogram. We decided to conduct close observations as a treatment for the patient because of acute subdural hematoma and sufficient contralateral cerebral flow by perfusion SPECT scan. Two weeks after the accident, he was treated with heparin anticoagulation within INR 2~4 ranges. He recovered as the motor grade 4 without another neurologic deficit after 3 months.

• 대한한방내과학회지
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• 제18권2호
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• pp.151-159
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• 1997

Fructus Tribuli has been used in Korea for many centuries as a therapeutic agent for headache and dizziness due to hyperactivity of the liver-yang. The effect of Fructus Tribuli on the blood pressure is not known. The purpose of this study was to determine the effect of Fructus Tribuli on blood pressure and artery rats and rabbits. 1. Fructus Tribuli exerted a dose-dependent relaxation of isolated rabbit common carotid artery. 2. Blood pressure was significantly decreased by Fructus Tribuli (10.0mg/kg) in rats.

• 한국가축번식학회지
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• 제22권1호
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• pp.67-72
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• 1998

Nowadays many kinds of foreign breed horse and Korean native Cheju horse are raised in Korea. Horse has complicated structure and function to maintain normal health, and to overcome severe condition during gallop at full speed. Sometimes the disease take a bad turn becuase of difficulty of correct diagnosis for horse disease. In recent times, horse farm for fattening and reproduction is gradually increasing. However, thoracic disease and abdominal disease are frequently occuring by defect in raising management. But the diagnosis of these kinds of disease is difficult by former diagnostic method. Ultrasonographic diagnostic method is a method to slove the problem. In abroad, nowadays ultrasonography has been reported for circulatory organs and abdomonal organs in horse, cattle, sheep, and dog, and the importance of ultrasonographic diagnosis is recognized in veterinary clinical medicine. In the country, ultrasonography of Korean native goat, cattle and dog was recently reported, but there was no report for the ultrasonography of horse. So, ultrasonogram for the thyroid glands, jugular vein and carotid artery was evaluated in Cheju horse and Thoroughbred horse. Thyroid gland, jugular vein and carotid artery were determined on both sides of neck. The length of right thyroid lobe at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 54.8, 45.1, 46.1 and 42.2 mm, respectively. The width of right thyroid lobe at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 18.1, 14.3, 14.6 and 14.2 mm, respectively. The height of right thyroid lobe at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 27.3, 25.6, 26.2 and 25.5 mm, respectively. Similar ultrasonographic measurements were obtained for the left thyroid gland. The internal diameter of left jugular vein at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 10.6, 9.7, 10.5 and 9.2 mm, respectively. Similar ultrasonographic measurements were obtained for the right jugular vein. The internal diameter of right carotid artery at the Thoroughbred horse, Thoroughbred foul, Cheju horse and Cheju foul were 9.5, 8.8, 9.1 and 8.5 mm, respectively. Similar ultrasonographic measurements were obtained for the left carotid artery. It is concluded that the ultrasonographic values of this study provides references for the diagnosis of morphologic changes in the thyroid gland, jugular vein and carotid artery in Korean native Cheju horse and Thoroughbred horse.

• Journal of Korean Neurosurgical Society
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• 제59권5호
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• pp.449-457
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• 2016

Objective : Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. Methods : The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. Results : Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. Conclusion : Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.313-320
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• 2014

Objective : The purpose of this study is to demonstrate the technical feasibility and clinical efficacy of emergent carotid angioplasty and stenting (CAS) for acute stroke due to athero-thrombotic occlusion of the cervical internal carotid artery (ICA). Methods : Review of medical records identified 17 patients who underwent emergent CAS for treatment of athero-thrombotic occlusion of the cervical ICA with acute stroke between 2009 and 2013. Eleven patients (64.7%) presented with concomitant intracranial artery occlusion, which was treated primarily by mechanical thrombectomy after CAS. Results : Successful revascularization of the cervical ICA with emergent CAS was achieved in all patients. After CAS, intracranial recanalization with Thrombolysis in Cerebral Infarction ${\geq}2b$ flow was achieved in four of the 11 patients (36.4%). The overall recanalization rate (cervical ICA and intracranial artery) was 10 of 17 patients (58.8%). Symptomatic intracranial hemorrhage occurred in two patients (11.8%), resulting in death. Ten patients (58.8%) showed improvement (decrease in NIHSS score of ${\geq}4$ points) at seven days after recanalization. Nine patients (52.9%) showed a favorable outcome ($mRS{\leq}2$) at the last follow-up. A favorable outcome ($mRS{\leq}2$) was obtained in four of the six patients with isolated cervical ICA occlusion (4/6, 66.7%) and five of 11 patients with intracranial tandem occlusion (5/11, 45.5%). Conclusion : Emergent CAS for acute stroke due to athero-thrombotic occusion of the cervical ICA showed a good technical feasibility and favorable clinical outcome.

• Journal of Korean Neurosurgical Society
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• 제61권1호
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• pp.28-34
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• 2018

Objective : Duplication of the vertebral artery (VA) is a rare vascular variant. This paper describes the anatomy and embryological development of duplicated VAs and reviews the clinical significance. Methods : Computed tomography (CT) angiography was performed in 3386 patients (1880 females, 1506 males) between March 2014 and November 2015. We defined duplication of the VA as a condition in which the VA has two origins that fused at different levels of the neck. Results : Ten of the 3386 patients (0.295%) who received CT angiography had a dual origin of the VA; three on the left side, and seven on the right side. In all seven with right dual origin of the VA, both limbs of the VA origin originated from the right subclavian artery. In all three patients with left dual origin of the VA, both limbs of the VA originated from the left subclavian artery and aortic arch. In all 10 patients, the medial limb of the duplicated VA was located posteriorly and medially to the common carotid artery (CCA) and anteriorly and laterally to the vertebral transverse foramen. In two patients, the medial limb of the duplicated VA was located in close proximity to the CCA. In another two patients, the medial limb of the duplicated VA was located in close proximity to the CCA, carotid bifurcation, and proximal internal carotid artery. Conclusion : Although duplication of the VA is asymptomatic in most patients, clinicians should consider this anomaly during diagnosis and treatment.

• Annals of Clinical Neurophysiology
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• 제18권1호
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• pp.1-6
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• 2016

Background: Moyamoya disease is characterized by a progressive stenosis or occlusion of the intracranial internal carotid artery and/or the proximal portion of the anterior cerebral artery and middle cerebral artery. Whether the onset time was childhood or adulthood, the bony carotid canal diameter might be different, but reflects the size of internal carotid artery passing through the bony carotid canal. In this study, we aimed to identify the relationship between bony carotid canal diameter and clinical manifestation. Methods: 146 consecutive patients diagnosed with moyamoya disease by brain imaging studies were included. We measured the diameter of a transverse portion of bony carotid canal on bone window of a brain computed tomography(CT) image. Patients were divided into two groups, ischemic or hemorrhagic stroke according to clinical manifestation. As a result, 115 patients were included. The Suzuki stage was used as criteria for disease progression. Results: Bony carotid canal diameter was $3.6{\pm}0.5$ (right) and $3.6{\pm}0.4$ (left) in the hemorrhagic stroke group, and $3.7{\pm}0.4$ (right) and $3.6{\pm}0.4$ (left) in the ischemic stroke group. The bony carotid canal diameter of the moyamoya vessels (3.6 mm) was smaller than the diameter of non-moyamoya vessels (3.8 mm), significantly (p = 0.042). However, there was no difference in the collateral patterns and clinical manifestation in a comparison of both groups. Conclusions: In our study, there was no significant difference of clinical manifestations and collateral patterns depend on the bony carotid canal diameter in patients with moyamoya disease. These findings suggest that the clinical presentations of moyamoya disease are not related to the onset time of the disease.

• 대한한방내과학회지
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• 제30권2호
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• pp.422-430
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• 2009

Background : Stroke is the second leading cause of death in Korea, following cancer. Stroke consists of ischemic and hemorrhagic stroke, and ischemic stroke can be largely classified as atherothrombotic stroke or embolic stroke. Carotid intima-media thickness (IMT) is an indicator of atherosclerosis used commonly as a screening test for abnormalities of the coronary artery. 24-hour ambulatory ECG is widely used to screen for underlying diseases that causes syncope, palpitation, arrhythmia, etc. Objectives : Since both carotid IMT and 24-hour ambulatory ECG are used to screen for cardiac problems, we endeavored to explore the correlation between carotid IMT and 24-hour ambulatory ECG of stroke patients. Methods : The records of ischemic stroke patients who were admitted to Kyunghee Medical Center Oriental Hospital ward from March 2006 to May 2009 were reviewed. 28 patients who had both carotid Doppler US and 24-hour ambulatory ECG test undertaken during their admission were analyzed. The relationship of abnormal ambulatory results and common carotid artery(CCA) IMT were statistically analyzed using Fisher's exact test and t-test. Results : The mean age of the abnormal ambulatory group was older than the normal group (74${\pm}$ 8.0 vs. 61${\pm}$12.1, p=0.0098). Although insignificant, the abnormal ambulatory group showed much thicker CCA-IMT than normal ambulatory group (2.l7${\pm}$ 1.16 vs. 1.51${\pm}$0.97. p=0.l389). Conclusion: No significant correlation was observed between abnormal ambulatory results and CCA-IMT. However, the difference in CCA-IMT between the two groups was too big to be ignored and further investigation with larger and better controlled trials are warranted.