• The Journal of Internal Korean Medicine
• /
• v.30 no.2
• /
• pp.422-430
• /
• 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.

• Korean Journal of Clinical Laboratory Science
• /
• v.53 no.1
• /
• pp.131-136
• /
• 2021

Duplex sonography is used widely in various medical fields because of its repeatability and low cost. In particular, the carotid duplex sonography is a useful non-invasive test for diagnosing cerebrovascular disease and predicting the prognosis. In clinical practice, it is very important to reduce the test time and improve accuracy. The patient's clinical information must be known in advance to perform carotid duplex sonography quickly and accurately. Despite this, there are often difficulties finding new cervical vascular diseases that are not mentioned in the clinical information. Therefore, knowing a variety of cases can lead to fast and accurate results. In this context, this paper reports three cases of cervical vascular disease discovered unexpectedly during carotid duplex sonography: CASE 1, internal carotid artery occlusion and cerebral arteries branched from the external carotid artery; CASE 2, internal jugular vein thrombosis; CASE 3, microembolism observed in the vertebral artery.

• Journal of Digital Convergence
• /
• v.10 no.9
• /
• pp.391-396
• /
• 2012

The purpose of this study was to present basic research data to utilize magnetic resonance imaging (MRI) with analyzing intracerebral regional distributions of ischemic cerebrovascular disease of middle aged and oldest-old aged people. We retrospectively analyzed middle-aged group (average age of 44.2 year-old, 43 males, 26 females) and oldest-old aged group (average age of 84.7 year-old, 58 males, 71 females) who taken MRI screening for ischemic cerebrovascular disease from May 2006 year to January 2008 year. The intracerebral vascular were classified into 8 vessels, which anterior communication artery (ACoA), posterior communication artery (PCoA), anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), internal carotid artery (ICA), common carotid artery(CCA), and basilar artery (BA). The result of middle-aged group showed that more ischemic cerebrovascular diseases appeared in men than women, and it affected in MCA mostly. In oldest-old aged group, ischemic cerebrovascular diseases occurred evenly spaced in intracerebral region of right, left, and both vessels, and women have more than men. For men, the most occurred in ICA and for women the most occurred in MCA. Specially middle-aged group in men showed that more ischemic cerebrovascular diseases in MCA appeared than oldest-old aged group in men. It is suggested that the analysis on ischemic cerebrovascular could be helpful in the clinical diagnosis and treatment.

• The Journal of Internal Korean Medicine
• /
• v.31 no.3
• /
• pp.467-476
• /
• 2010

Object : The purpose of this study was to investigate the correlation of atherosclerosis risk factors and pulse wave velocity (PWV) of carotid-femoral artery with Sasang constitution. This study also aimed to investigate the relationship between PWV and risk factors of atherosclerosis, including serum cholesterol and homosisteine, hs-CRP. Methods : We enrolled 160 patients without experience strokes who visited our hospital for a medical examination from January 1, 2008 to April 30, 2010 except patients whose body constitutions were undetermined according to QSCCII. We investigated the correlation between serum cholesterol values, blood pressure, body mass index(BMI), homosistein, hs-CRP and PWV. Pearson's correlation and partial correlation analysis were applied to examine the relationship between PWV and risk factors of atherosclerosis. Result : Among the 160 subjects, 54 were Taeumin, 54 were Soyangin, and 52 were Soeumin. The prevalences of high BMI (P-value <0.01), high hs-CRP(P-value <0.05), and high PWV(P-value <0.05) of Taeumin were higher than those of the other constitutions. PWV of carotid-femoral artery was significantly different among the three constitutional groups(Taeumin: $8.12{\pm}1.64m/sec$, Soyangin: $7.48{\pm}1.16m/sec$, Soeumin: $7.49{\pm}1.12m/sec$)(P-value <0.05). This research has show a statistical significance between the average amount of carotid-femoral artery PWV that is higher in Taeumin. Age factor of Taeumin was the effective determinant of the increase of mean PWV of carotid-femoral arteries. Conclusions : There were significant differences in the prevalence of atherosclerosis according to Sasang constitution. This study showed that atherosclerosis was more prevalent in Taeumin. Therefore, according to our results, risk of atherosclerosis was higher in Taeumin than among other constitutions.

• Journal of Korean Neurosurgical Society
• /
• v.62 no.2
• /
• 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.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.5
• /
• pp.287-289
• /
• 2011

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

• Journal of Korean Neurosurgical Society
• /
• v.63 no.6
• /
• pp.834-840
• /
• 2020

Objective : Carotid endarterectomy (CEA) is an effective surgical procedure for treating symptomatic or asymptomatic patients with carotid stenosis. Many neurosurgeons use a shunt to reduce perioperative ischemic complications. However, the use of shunting is still controversial, and the shunt procedure can cause several complications. In our institution, we used two types of modified arteriotomy suture techniques instead of using a shunt. Methods : In technique 1, to prevent ischemic complications, we sutured a third of the arteriotomy site from both ends after removing the plaque. Afterward, the unsutured middle third was isolated from the arterial lumen by placing a curved Satinsky clamp. And then, we opened all the clamped carotid arteries before finishing the suture. In technique 2, we sutured the arteriotomy site at the common carotid artery (CCA). We then placed a curved Satinsky clamp crossing from the sutured site to the carotid bifurcation, isolating the unsutured site at the internal carotid artery (ICA). After placing the Satinsky clamp, the CCA and external carotid artery (ECA) were opened to allow blood flow from CCA to ECA. By opening the ECA, ECA collateral flow via ECA-ICA anastomoses could help to reduce cerebral ischemia. Results : The modified suture methods can reduce the cerebral ischemia directly (technique 1) or via using collaterals (technique 2). The modified arteriotomy suture techniques are simple, safe, and applicable to almost all cases of CEA. Conclusion : Two modified arteriotomy suture techniques could reduce perioperative ischemic complications by reducing the cerebral ischemic time.

• Korean Journal of Head & Neck Oncology
• /
• v.33 no.2
• /
• pp.67-70
• /
• 2017

We present a metastatic carcinoma from the breast to the neck soft tissue around common carotid artery, with a rare finding of voice change. A 60 year-old female patient presented with voice change for 7 months. Neck ultrasound revealed a soft tissue mass between internal jugular vein and common carotid artery. Result of fine needle aspiration biopsy was a metastatic carcinoma. Computed tomography and magnetic resonance image revealed $2.5{\times}3.0cm$ sized irregular marginated soft tissue mass in right lower neck encasing common carotid artery and internal jugular vein. Surgical resection was performed and pathologic result with immunohistochemical analysis confirmed the diagnosis of a metastatic invasive ductal carcinoma originated from breast.

• Korean Journal of Bronchoesophagology
• /
• v.12 no.2
• /
• pp.35-41
• /
• 2006

Traumatic pseudoaneurysm of the intracavernous internal carotid artery(ICA) is extremely rare, but it is life threatening condition because of massive recurrent epistaxis. Unfortunately, the prompt diagnosis and treatment of this disease are frequently delayed due to its rarity and variable latent period, so this disease is regarded as a challenge to clinicians. Optimal therapy for this diseases demands rapid suspicion for it and is essential in order to give the best functional outcome with minimizing its morbidity and mortality. The authors present a case of male patient with traumatic pseudoaneurysm of intracavernous ICA accompanying severe epistaxis. This patient was a 37-year-old male with unilateral blindness and recurrent massive epistaxis after suffering trauma to head. Computed tomography, MRI and carotid artery angiogram showed pseudoaneurysm of intracavernous ICA with sphenoid bone fracture. The patient was effectively managed with occlusion of the pseudoaneurysmal circulation by endovascular interventional embolization technique utilizing mechanically detachable tungsten coils.

• Investigative Magnetic Resonance Imaging
• /
• v.17 no.1
• /
• pp.55-58
• /
• 2013

Persistent proatlantal artery (PPA) is a rare embryologically remnant carotico-vertebrobasilar anastomoses. There are two types of PPA according to embryological considerations, origin and anatomic course. Type I PPA usually originate from internal carotid artery and not traversing transverse foramen. Type II PPA traverses from external carotid artery to C1 transverse foramen. The PPA is usually found incidentally without clinical symptoms, but can be related to several clinically significant vascular lesions, such as hypoplastic vertebral artery, intracranial arteriovenous malformation and in a case of carotid endarterectomy or external carotid artery embolization. So, thorough understanding of this anomaly is needed and we report a case of type II PPA diagnosed by MR angiography.