• Journal of Korean Neurosurgical Society
• /
• v.64 no.2
• /
• pp.198-206
• /
• 2021

Objective : The low-profile Neuroform Atlas stent can be deployed directly without an exchange maneuver by navigating into the Gateway balloon. This retrospective study assessed the safety and efficacy of Neuroform Atlas stenting as a rescue treatment after failure of mechanical thrombetomy (MT) for large artery occlusion. Methods : Between June 2018 and December 2019, a total of 31 patients underwent Neuroform Atlas stenting with prior Gateway balloon angioplasty after failure of conventional MT caused by residual intracranial atherosclerotic stenosis (ICAS). Primary outcomes were successful recanalization and patency of the vessel 24 hours after intervention. Secondary outcomes were vessel patency after 14 days and 3-month modified Rankin Scale. Peri-procedural complications, intracerebral hemorrhage (ICH), and 3-month mortality were reviewed. Results : With a 100% of successful recanalization, median value of stenosis was reduced from 79.0% to 23.5%. Twenty-eight patients (90.3%) showed tolerable vessel patency after 14 days. New infarctions occurred in three patients (9.7%) over a period of 14 days; two patient (6.5%) underwent stent occlusion at 24 hours, and the other patient (3.2%) with delayed stent occlusion had a non-symptomatic dot infarct. There were no peri-procedural complications. Two patients (6.5%) developed an ICH immediately after the procedure with one of them is symptomatic. Conclusion : Neuroform Atlas stenting seems to be an effective and safe rescue treatment modality for failed MT with residual ICAS, by its high successful recanalization rate with tolerable patency, and low peri-procedural complication rate. Further multicenter and randomized controlled trials are needed to confirm our findings.

• The Korea Journal of Herbology
• /
• v.23 no.3
• /
• pp.1-9
• /
• 2008

Objectives : This research was performed to investigate protective effect of Sophora Subprostrata against transient global ischemic damage after 5-min two vessel occlusion. Methods : Gerbils were divided into three groups: Normal group, 5-min two vessel occlusion (2VO) group, Sophora Subprostrata administrated group after 2VO. The CCAs were occluded by microclip for 5min. Sophora Subprostrata was administrated orally(12mg/ml) for 7 days after 2VO. The histological and immunohistochemistrical analysis was performed at 72 hours and 7 days after the surgery each. For histological analysis, the brain tissue was stained with 1% cresyl violet solution and Immunohistochemistry for BAX and Bcl-2 was carried out to examine effect of Sophora Subprostrata on ischemic brain tissue. Results : The results showed that (1) Sophora Subprostrata has the protective effect against ischemia in CA1 area of the gerbil hippocampus 7 days after 5-minute occlusion, (2) the treatment of Sophora Subprostrata inhibits the expression of Bax relatively after 2VO-induced ischemia. That protective effect of the Sophora Subprostrata seems to be performed by regulating the proportion of Bax and Bcl-2 protein, (3) in hypoxia/reperfusion model using PC12 cell, the Sophora Subprostrata extract has the protective effect against ischemia in the dose of $2{\mu}/m{\ell}$ and $20{\mu}/m{\ell}$.This study suggests that Sophora Subprostrata has neuroprotective effect against neuronal damage following cerebral ischemia in vivo with a widely used experimental model of cerebral ischemia in Mongolian gerbils and that Sophora Subprostrata regulates the proportion of Bax and Bcl-2 protein following ischemia. And, Sophora Subprostrata extract has protective effects also on a hypoxia/reperfusion cell culture model using PC12 cell. Conclusions : Sophora Subprostrata has protective effects against ischemic brain damage at the early stage of ischemia.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.4
• /
• pp.491-499
• /
• 2000

Objective : In the cerebral aneurysm surgery, the goal is complete circulatory exclusion of the aneurysm without compromise of normal vessels. In an operating room, an operator should confirm the completeness and precision of the surgical result, before closing the wound. Object of this study was to determine which cases require intraoperative angiography. Methods : We reported our experience with 48 intraoperative angiographic studies performed during the surgical treatment of cerebral aneurysm of these 48 cases. There were 5 giant(10.4%), 15 globular(1.5-2.5cm)(31.25%) and 28 saccular(58.3%) aneurysm. We recorded the incidence of unexpected findings, such as residual aneurysms, major vessel occlusions. Using Fischer's exact test, we assessed whether unexpected angiographic findings showed any correlation with aneurysm site, size and clinical findings. Results : In 5 cases(10.4%), we detected unexpected angiographic findings which resulted in clip adjustment. By means of clip adjustment, an operator could restore the flow of two major arterial occlusion(4.2%) and also obliterate three persistent filling aneurysms(6.3%). Globular aneurysm was the only factor to predict unexpected angiographic findings(p<0.05). The subgroup of globular and giant aneurysm has a high risk of occlusion of the parent artery and its branches and/or residual aneurysm. There were two minor complications related to this procedure. Conclusion : Intraoperative assessment makes it possible to recognize and correct the technical defect. Particularly in globular aneurysm, we were able to prevent both the chance for another operation and the risk of postoperative complications.

• Journal of Chest Surgery
• /
• v.28 no.9
• /
• pp.876-880
• /
• 1995

The optimal surgical approach to the patients with coronary artery disease combined with carotid artery stenosis is controversial. We report two cases of successful surgical management of the patients with combined obstructive coronary and carotid artery disease. The first case was a 69-year-old female who had unstable angina pectoris and a past medical history of left carotid endarterectomy. She was revealed to have triple vessel coronary disease and nearly total occlusion of right internal carotid artery. She was undergone staged right carotid endarterectomy 10 days before coronary bypass surgery. The second case, a 54-year-old male with a past medical history of left hemiparesis and dysarthria, was admitted due to unstable angina pectoris. He was revealed to have triple-vessel coronary disease and more than 90% stenosis of left internal carotid artery and 50% stenosis of right internal carotid artery. In the latter case, a combined coronary bypass surgery and left carotid endarterectomy was done. In both cases, postoperative neurologic complications were not observed.

• Archives of Reconstructive Microsurgery
• /
• v.9 no.1
• /
• pp.15-22
• /
• 2000

One hundred & seventy four consecutive free-flap transfers were reviewed to analyze distribution of the type of reconstructions, kinds of donor flaps as well incidence of complications. The role of emergent exploration and the effect of preoperative wound conditions in flap survival were evaluated. Free flap transfer for head and neck reconstruction was most common as 93 cases, followed by for upper extremity of 30 cases, for lower extremity 30 cases, 18 penile reconstructions and for trunk & breast 3 cases. Nine flaps exhibited signs of ciruclatory insufficiency between 5 hours and 7 days. Three were managed conservatively with ultimate partial necrosis of the flaps. Eight flaps required return to the operating room. On exploration, early arterial occlusion was revealed in 1 flap, late arterial occlusion in 2 flaps, early venous occlusion in 1 flap, late venous thrombosis in 2 flaps, prolonged venous spasm in 1 and hematoma in 1 flap. The average time from the first abnormal examination to exploration was 2.6 hours. There were no false-positive explorations. Four free flaps failed in spite of the correction of the cause of circulatory compromise. The remaining 4 flaps were salvaged following the correction the casuse. Recipient vessel problems such as irradiation and infection were the most common cause of circulatory crisis. Among the eight flaps requiring return to the operating room, single vein was anastomosed in three flaps and two veins in the remaining five. In the totally failed four flaps only single vein was anastomosed in three cases. The results of this study demonstrate the efficacy of clinical monitoring and the role of early exploration. Precautious selection of recipient vessels and two vein anastomosis are recommended for safe and better prognosis.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.6
• /
• pp.497-502
• /
• 2011

Objective : This study was conducted to compare the effect of etomidate with that of thiopental on brain protection during temporary vessel occlusion, which was measured by burst suppression rate (BSR) with the Bispectral Index (BIS) monitor. Methods : Temporary parent artery occlusion was performed in forty one patients during cerebral aneurysm surgery. They were randomly assigned to one of two groups. General anesthesia was induced and maintained with 1.5-2.5 vol% sevoflurane and 50% $N_2O$. The pharmacological burst suppression (BS) was induced by a bolus injection of thiopental (5 mg/kg, group T) or etomidate (0.3 mg/kg, group E) according to randomization prior to surgery. After administration of drugs, the hemodynamic variables, the onset time of BS, the numerical values of BIS and BSR were recorded at every minutes. Results : There were no significant differences of the demographics, the BIS numbers and the hemodynamic variables prior to injection of drugs. The durations of burst suppression in group E ($11.1{\pm}6.8$ min) were not statistically different from that of group T ($11.1{\pm}5.6$ min) and nearly same pattern of burst suppression were shown in both groups. More phenylephrine was required to maintain normal blood pressure in the group T. Conclusion : Thiopental and etomidate have same duration and a similar magnitude of burst suppression with conventional doses during temporary arterial occlusion. These findings suggest that additional administration of either drug is needed to ensure the BS when the temporary occlusion time exceed more than 11 minutes. Etomidate can be a safer substitute for thiopental in aneurysm surgery.

• Archives of Plastic Surgery
• /
• v.40 no.5
• /
• pp.505-509
• /
• 2013

Background The aim of this study was to collect important data on the time of oxygen saturation change in relation to skin flap color alteration using non-invasive pulse oximetry to evaluate its ability to provide continuous monitoring of skin flap perfusion. Methods An experimental study on the monitoring of blood perfusion of 20 tube-island groin flaps of 10 male New Zealand rabbits was performed using pulse oximetry. The animals were randomly assigned to one of two groups representing a blockage of either arterial or venous blood flow. The oxygen saturation change and clinical color alteration were monitored from the beginning of vessel clamping until the saturation became undetectable. The result was analyzed by the t-test using SSPS ver. 10.0. Results The mean times from the vessel clamping until the saturation became undetectable were $20.19{\pm}2.13$ seconds and $74.91{\pm}10.57$ seconds for the artery and vein clamping groups, respectively. The mean time of the clinical alteration from the beginning of vein clamping was $34.5{\pm}11.72$ minutes, while the alteration in flaps with artery clamping could not be detected until 2.5 hours after clamping. Conclusions The use of neonate-type reusable flex sensor-pulse oximetry is objective and effective in early detection of arterial and vein blockage. It provides real-time data on vessel occlusion, which in turn will allow for early salvaging. The detection periods of both arterial occlusion and venous congestion are much earlier than the color alteration one may encounter clinically.

• Journal of Chest Surgery
• /
• v.37 no.3
• /
• pp.220-227
• /
• 2004

The number of patients with coronary artery disease and peripheral vascular disease are increasing, and the need of small diameter vessel is also increasing. We developed small diameter artificial vessel and experimented in vivo. We got allogenic valve from mongrel dogs, and removed all cells from the allogenic valve. Then, we seeded autologous bone marrow cells onto the decellularized scaffold. After implantation of artificial vessel into the canine carotid artery, we performed angiography regularly. In case of vessel occlusion or at 8 weeks after operation, we euthanized dogs, and retrieved the implanted artificial vessels. Control vessels were all occluded except one (which developed aneurysmal dilatation). But autologous cell seeded vascular graft were patent by 4 weeks in one, by 6 in one and by 8 weeks in two. Histologic examination of patent vessel revealed similar structure to native artery. Tissue-engineered vascular graft manufactured with decellularized allogenic matrix and autologous bone marrow cells showed that tissue engineered graft had similar structure to native artery.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.1
• /
• pp.1-7
• /
• 2011

Objective: Glutamate is a key excitatory neurotransmitter in the brain, and its excessive release plays a key role in the development of neuronal injury. In order to define the effect of nimodipine on glutamate release, we monitored extracellular glutamate release in real-time in a global ischemia rat model with eleven vessel occlusion. Methods: Twelve rats were randomly divided into two groups: the ischemia group and the nimodipine treatment group. The changes of extracellular glutamate level were measured using microdialysis amperometric biosensor, in coincident with cerebral blood flow (CBF) and electroencephalogram. Nimodipine (0.025 ${\mu}g$/100 gm/min) was infused into lateral to the CBF probe, during the ischemic period. Also, we performed Nissl staining method to assess the neuroprotective effect of nimodipine. Results: During the ischemic period, the mean maximum change in glutamate concentration was $133.22{\pm}2.57\;{\mu}M$ in the ischemia group and $75.42{\pm}4.22\;{\mu}M$ (p<0.001) in the group treated with nimodipine. The total amount of glutamate released was significantly different (P<0.001) between groups during the ischemic period. The %cell viability in hippocampus was $47.50{\pm}5.64$ (p<0.005) in ischemia group, compared with sham group. But, the %cell viability in nimodipine treatment group was $95.46{\pm}6.60$ in hippocampus (p<0.005). Conclusion: From the real-time monitoring and Nissl staining results, we suggest that the nimodipine treatment is responsible for the protection of the neuronal cell death through the suppression of extracellular glutamate release in the 11-VO global ischemia model of rat.

• Journal of Ginseng Research
• /
• v.31 no.1
• /
• pp.44-50
• /
• 2007

Ginseng powerfully tonifies the original Qi. Ginseng used for insomnia, palpitations with anxiety, restlessness from deficient Qi and blood and mental disorientation. In order to investigate whether Ginseng cerebral ischemia-induced neuronal and cognitive impairments, we examined the effect of Ginseng on ischemia-induced cell death in the hippocampus, and on the impaired learning and memory in the Morris water maze and passive avoidance in rats. Ginseng when administered to rat at a dose of 200 mg/kg i.p. water extracts to 0 minutes and 90 minutes after 4-VO, significantly neuroprotective effects by 86.4% in the hippocampus of treated rats. For behavior test, rats were administered Ginseng (200mg/kg p.o.) daily for two weeks, followed by their training to the tasks. Treatment with Ginseng produced a marked improvement in escape latency to find the platform in the Morris water maze. Ginseng reduced the ischemia-induced learning disability in the passive avoidance. Consistent with behavioral data, treatments with Ginseng reduced jschemia-induced cell death in the hippocampal CA1 area. Oxidative stress is a causal factor in the neuropathogenesis of ischemic-reperfusion injury. Oxidative stress was examined in a rat model of global brain ischemia. The effects of Ginseng on lipid peroxidation (inhibition of the production of malondialdehyde, MDA) in different regions of the rat brain were studied. Ferrous sulfate and ascorbic acid (FeAs) were used to induce lipid peroxidation. The antiperoxidative effect showed 48-72% protection from tissue damage as compared with untreated animals. These results showed that Ginseng have a protective effect against ischemia-induced neuronal loss and learning and memory damage.