• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.8
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• pp.84-87
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• 2017

Cerebral hyperperfusion syndrome (CHS) is a rare complication that can occur when conducting stent insertion or endarterectomy in patients with carotid artery stenosis and is known to be caused by various mechanisms when the blood volume abruptly increases. The main clinical symptoms are unilateral headache, hypertension, seizure, and focal neurologic deficit. Subarachnoid hemorrhage and parenchymal hemorrhage may lead to permanent impairment or death in severe cases. CHS can be predicted by using transcranial Doppler, perfusion magnetic resonance imaging, and single photon emission computed tomography. In our case report, a patient developed CHS subsequent to significant venous congestion caused by carotid artery stent insertion. The patient had preexisting, symptomatic bilateral carotid artery stenosis. Venous congestion occurs when the direction of blood flow changes because of increased blood volume in patients with well-developed collateral vessels. We believe that CHS can be predicted from this finding. This study reports the possibility that CHS could be confirmed by cerebral angiography after insertion of the internal carotid stent.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.51-55
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• 2006

Background: A cervical transforaminal steroid injection is an effective therapeutic modality for radiculopathy of a herniated cervical disc or a cervical foraminal stenosis. However, there is some debate regarding the safety of the transforaminal approach under C-arm guidance compared with the posterior interlaminar approach. We report a new technique for cervical transforaminal steroid injection guided by MDCT. Methods: Patients presenting with radiating pain on their shoulder or arm were diagnosed using CT or MRI of a cervical herniated disc or a foraminal stenosis. Each patient whose symptoms were compatible with the image scan was enrolled in this study. They received a cervical transforaminal steroid injection under CT guidance, and the effectiveness and complications of this technique were evaluated over a 2-month period. Results: According to the CT scan, none of the participants had an internal jugular vein or a carotid artery invasion during the procedure. No vertebral artery injection was noted, and no patient developed a hematoma after the injection. The VAS score had improved significantly by 2, 4 and 8 weeks after the injection. Conclusions: While a conventional C-arm guided cervical transforaminal steroid injection does not appear to differentiate between the major vessels and structures in images, a CT guided approach is a more useful and safer technique for the precise placement of a needle.

• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.422-429
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• 2022

Objective : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs. Methods : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed. Results : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5-77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91). Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.772-775
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• 2003

Moyamoya disease is an unusual cerebrovascular disorder characterized by occlusive intimal dysplasia of the distal internal carotid and proximal cerebral arteries, but the etiology remains unclear. Angiographic characteristics include bilateral stenosis or occlusion of the terminal portions of the intracranial internal carotid arteries and bilateral development of fine collateral vessels at the base of the brain known as ‘Moyamoya vessels’. Cardiac surgery using cardiopulmonary bypass due to coronary artery disease and others among patients with moyamoya disease is very rare, and cardiac surgery for such patients has a potential risk of intraoperative and perioperative brain ischemia. We successfully treated a patient who underwent artrial septal defect closure and coronary artery bypass graft using the cardiopulmonary bypass, so we report this case with a brief literature review.

• Korean Journal of Clinical Laboratory Science
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• v.49 no.3
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• pp.316-321
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• 2017

The occurrence of subclavian steal syndrome is possible in patients with either severe stenosis or occlusion in the left proximal subclavian or brachiocephalic arteries. Limited and insufficient blood flow in the vessel with a lesion induces blood supply from the opposite side via any of the connected vessels, which is called a subclavian steal phenomenon. The duplex sonography is useful for detecting this phenomenon. Some patients who experience this phenomenon complain of vertebrobasilar insufficiency, such as headache or numbness and weakness in the arm, and so on. Subclavian steal syndrome means subclavian steal phenomenon accompanied by these symptoms. We present a patient with focal severe stenosis of the brachiocephalic artery, manifested as blood flow reversal in the vertebral, and a "to-and-fro" waveform pattern in the external carotid, internal carotid, and common carotid arteries.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.140-147
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• 1994

Reconstruction of the pharynx and cervical esophagus presents a tremendous challenges to surgeons. Over the past 2 years[1990, Dec.-1993, Jun], the free jejunal graft has been performed in 17 cases in Korea Cancer Center Hospital.The indications of this procedures were almost malignant neoplasms involving neck and upper aero-digestive tract; Hypopharyngeal cancer[12 cases, including 2 recurrent cases], laryngeal cancer[2 cases], thyroid cancer[2 cases, including 1 recurrent case], cervical esophageal cancer[1 case]. There were fifteen men and two women, and the mean age was 59.6 years. The anastomosis site of jejunal artery were common carotid artery[16 cases] or external carotid artery[1 case] and that of jejunal vein were internal jegular [15 cases] or facial[1 case] and superior thyroid vein[1 case]. The length of jejunal graft was from 9 cm to 17 cm[mean 13 cm] and the mean ischemic time was 68 minutes. There was one hospital mortality which was irrelevant to procedures[variceal bleeding] and one graft failure[1/16]. Other postoperative complications were neck bleeding or hematoma[3 cases], abdominal wound infection or disruption[5 cases], anastomosis site leakage[1 case], pneumonia[2 cases], graft vein thrombosis[1 case], and food aspiration[1 case]. The function of conduit was excellent and ingestion of food was possible in nearly all cases. Postoperative adjuvant radiation therapy was also applicable without problem in 7 cases. During follow-up periods, the anastomosis site stenosis developed in four patients, and the tracheal stoma was narrowed in one case but easily overcome with dilation. In conclusion, we think that the free jejunal graft is one of the excellent reconstruction methods of upper digestive tract, especially after radical resection of malignant neoplasm in neck with a high success rate and low mortality and morbidity rate.

• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.801-815
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• 2022

Objective : To evaluate the stent apposition of a low-profile visualized intraluminal support (LVIS) device in distal internal carotid artery (ICA) aneurysms, examine its correlation with clinical and angiographic outcomes, and determine the predictive factors of ischemic adverse events (IAEs) related to stent-assisted coiling. Methods : We retrospectively analyzed a prospectively maintained database of 183 patients between January 2017 and February 2020. The carotid siphon from the cavernous ICA to the ICA terminus was divided into posterior, anterior, and superior bends. The anterior bends were categorized into angled (V) and non-angled (C, U, and S) types depending on the morphology and measured angles. Complete stent apposition (CSA) and incomplete stent apposition (ISA) were evaluated using unsubtracted angiography and flat-panel detector computed tomography. Dual antiplatelet therapy with aspirin 200 mg and clopidogrel 75 mg was administered. Clopidogrel resistance was defined as fewer responders (≥10%, <40%) and non-responders (<10%) based on the percent inhibition (%INH) of the VerifyNow system. These were counteracted by a dose escalation to 150 mg for fewer responders or substitution with cilostazol 200 mg for non-responders. IAEs included intraoperative in-stent thrombosis, transient ischemic attack, cerebral infarction, and delayed in-stent stenosis. A multivariate logistic regression analysis was used to determine the predictive factors for ISA and IAEs. Results : There were 33 ISAs (18.0%) and 27 IAEs (14.8%). The anterior bend angle was narrower in ISA (-4.16°±25.18°) than in CSA (23.52°±23.13°) (p<0.001). The V- and S-types were independently correlated with the ISA (p<0.001). However, treatment outcomes, including IAEs (15.3% vs. 12.1%), aneurysmal complete occlusion (91.3% vs. 88.6%), and recanalization (none of them), did not differ between CSA and ISA (p>0.05). The %INH of 27 IAEs (13.78%±14.78%) was significantly lower than that of 156 non-IAEs (26.82%±20.23%) (p<0.001). Non-responders to clopidogrel were the only significant predictive factor for IAEs (p=0.001). Conclusion : The angled and tortuous anatomical peculiarity of the carotid siphon caused ISA of the LVIS device; however, it did not affect clinical and angiographic outcomes, while the non-responders to clopidogrel affected the IAEs related to stent-assisted coiling.

• Journal of Korean Neurosurgical Society
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• v.57 no.6
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• pp.432-435
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• 2015

Moyamoya disease is a unique cerebrovascular disorder characterized by idiopathic progressive stenosis at the terminal portion of the internal carotid artery (ICA) and fine vascular network. The aim of this review is to present the clinical application of quantitative digital subtraction angiography (QDSA) in pediatric moyamoya disease. Using conventional angiographic data and postprocessing software, QDSA provides time-contrast intensity curves and then displays the peak time ($T_{max}$) and area under the curve (AUC). These parameters of QDSA can be used as surrogate markers for the hemodynamic evaluation of disease severity and quantification of postoperative neovascularization in moyamoya disease.

• The Journal of the Acoustical Society of Korea
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• v.36 no.5
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• pp.361-369
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• 2017

Hemodynamic information in the carotid artery bifurcation is very important for understanding the development and progression mechanisms of cerebrovascular disease and for its early diagnosis and prediction of the progress. In this paper, we constructed a mock pulsatile blood circulation system using an anthropomorphic elastic vessel of the carotid artery bifurcation and ex vivo pig blood to acquire ultrasound images from blood and vessels synchronized with internal pressure while controlling the blood flow. Echogenicity, blood flow velocity, and blood vessel wall motion from the ultrasound images, and internal blood pressure were extracted over a cycle averaged from five cycles when the pulsatile pump rates are 20 r/min, 40 r/min, and 60 r/min. As a result, respectively, the peak systolic blood flow velocities were 20 cm/s, 25 cm/s, and 40 cm/s, the blood pressure differences were 30 mmHg, 70 mmHg, and 85 mmHg, the arterial walls were expanded to 0.05 mm, 0.15 mm, and 0.25 mm. Time-delayed cyclic variation of echogenicity compared to blood flow and pressure was observed, but the variation was minimal at 20 r/min. Time-synchronized cyclic variations of these parameters are important information for accurate input parameters and validation of the computational hemodynamic experiments which will provide useful information for the development and progress mechanisms of carotid artery stenosis.

• Clinical and Experimental Pediatrics
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• v.56 no.12
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• pp.545-549
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• 2013

We report the case of a 17-year-old Korean girl with systemic lupus erythematosus (SLE) who presented with sudden weakness of the right-sided extremities and dysarthria. Oral prednisolone was being taken to control SLE. Results of clinical and laboratory examinations did not show any evidence of antiphospholipid syndrome or thromboembolic disease nor SLE activity. Cerebral angiography showed stenosis of the left internal carotid artery and right anterior cerebral artery with accompanying collateral circulation (moyamoya vessels). After the patient underwent bypass surgery on the left side, she recovered from the neurological problems and did not experience any additional ischemic attack during the 14-month follow-up period. This case represents an unusual association between moyamoya syndrome and inactive SLE (inactive for a relatively long interval of 2 years) in a young girl.