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하지 심부정맥혈전증 환자에서 폐색전증 발생에 미치는 인자
윤상섭,최승혜,김상동,조항주,박순철,김기환,안창혁,김정수,문인성,유승진,임근우,김지일 대한뇌혈관외과학회 2008 대한뇌혈관외과학회지 Vol.24 No.2
Purpose: Pulmonary embolism (PE) represents the most important and fatal complication of deep vein thrombosis (DVT), of which a dislodged thrombus is most commonly derived from the deep venous system of the lower extremity. The aim of this study is to define the incidence and risk factors of PE in DVT patients. Method: We retrospectively reviewed 248 patients with DVT in a lower extremity at Uijeongbu St. Mary's Hospital between January 2000 and August 2008 and they had received additional examinations for making the diagnosis of PE regardless of its symptoms. Result: There were 117 men and 131 women, and their mean age was 59 years old (range: 13∼91) at the time of diagnosis. There were 190 DVT-only patients and 58 patients with PE (the incidence rate of PE in the DVT patients: 23.8%). The gender ratio of the DVT only group was 1:1.3 (males: 83, female: 107) and the gender ratio of the DVT with PE group was 1:0.7 (males: 34, females: 24) (P<0.05). The risk factors of PE in the DVT patients were hypercoagulability (34%), cancer (23%), immobilization (17%), trauma/operation (10%), obesity (10%) and a past DVT history (7%). The idiopathic DVT patients had a relatively high cancer diagnosis rate (18.5%) and the majority of the newly detected cancer were from the chest or abdominal cavity. Conclusion: The incidence of DVT and PE is increasing and 23.8% of the DVT patients showed PE on their chest CT scan. The most significant risk factor for PE in the DVT patients was the male gender, yet an evaluation for cancer should be carefully done for idiopathic DVT patients because of their high rate of having cancer diagnosed.
Jun Hyoung Lee,Ji Kwang Yun,김대원,강성돈 대한뇌혈관외과학회 2012 Journal of Cerebrovascular and Endovascular Neuros Vol.14 No.3
Objective:The limitations of medical management of symptomatic intracranial arterial stenosis (ICS) have prompted development of new strategies, including endovascular treatment. However, stenting of symptomatic ICS remains investigational. Here, we have reported and analyzed a series of 19 endovascular procedures involving placement of a Wingspan stent. Methods:We conducted a retrospective review of a series of ICS in which patients were treated with percutaneous transarterial balloon angioplasty and stent placement (PTAS). Patients included in the study were diagnosed as symptomatic ICS between May 2010 and September 2011. Results:Nineteen patients (median age, 65 years; 12 males, seven women) were treated with the Wingspan stent system for symptomatic ICS ranging from 50% to 99%. The technical success rate was 100%. The location of ICS included the internal carotid (n = 5; 1 petrous, 3 cavernous, and 1 clinoid segments), vertebral (n = 1; V4 segment), basilar (n = 1), and middle cerebral (n = 12; 9 M1, 3 M2) arteries. There was no occurrence of procedure-related mortality. Periprocedural morbidity occurred in two cases (10.5%), including carotid-cavernous fistula (n = 1) and subarachnoid hemorrhage (n = 1). No ipsilateral stroke was recorded beyond 30 days during a mean follow-up period of 13.2 months (range 9–19 months). Restenosis (> 50%) was observed in one patient (6.3%), who was asymptomatic, on follow-up imaging. Conclusion:Wingspan stent for symptomatic ICS can be performed with a high rate of technical success and acceptable periprocedural morbidity rates. Our initial experience indicates that this procedure represents a viable treatment option for this patient population.
Jiyong Park,황승균 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.4
Objective: Pulsatility index (PI) is a parameter calculated by transcranial Doppler sonography (TCD), which is commonly used for patients with subarachnoid hemorrhage or ischemic stroke. However, we performed a retrospective analysis of patients with acute spontaneous intracerebral hemorrhage (ICH) to assess the function of TCD, particularly the PI. Methods: This study involved a total of 46 patients with acute ICH who received treatment at a single center between May 2013 and December 2014. Medical records of baseline characteristics, except for the modified Rankin scale, were obtained at initial evaluation in the emergency room, and TCD was used to calculate middle cerebral artery flow velocity (MFV) and PI at admission (baseline), 24 h, and 7 days. The PI and MFV values on the affected middle cerebral artery were compared with those on the contralateral side. Linear regression analysis was used for statistical analyses (SPSS 21.0, IBM Corp., Armonk, NY, USA). Results: Statistical analysis indicated that sex, age, Glasgow coma scale, intraventricular hemorrhage, and hematoma size were not correlated with PI (p>0.05); however, only PI was positively correlated with functional outcome at 6 months after treatment (R=0.846, p=0.002). Conclusions: These results provide evidence that the parameter of PI is an independent determinant prognostic factor in acute spontaneous ICH. Further research is needed to investigate the influence of cerebral blood flow dynamics on a larger, more controlled, and more randomized basis.
Gigliotti Michael J,Savaliya Sandip,Schlauderaff Abraham,Kelleher John P,Cockroft Kevin M 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.3
Vertebral artery injuries account for approximately 19% of cerebral vascular injuries and are typically managed conservatively. However, some patients require operative intervention to gain control of an active hemorrhage, either via surgical ligation or endovascular intervention. We present a case of iatrogenic vertebral artery injury occurring during cervical spine surgery which was treated emergently with a self-expanding covered stent. A 58-year-old male presented for cervical traction, C5 and C6 corpectomy, and possible C4 to T2 posterior fusion following a motor vehicle accident. Intraoperatively, following drilling the C5 endplate, copious bleeding was observed from injury to the right vertebral artery resulting in pseudoaneurysm formation. The patient was loaded with ticagrelor and a self-expanding covered stent was placed via a transfemoral approach, resulting in obliteration of the pseudoaneurysm prior to completion of his cervical spine surgery. Emergent self-expanding covered stent placement for iatrogenic vertebral artery injury in the setting of an intraoperative injury is a safe and effective option. Ticagrelor is a viable alternative to traditional dual antiplatelet therapy for preventing thromboembolic complications in this urgent setting.
양지원,신동진,박현미,박기형,성영희,이영배 대한뇌혈관외과학회 2011 Journal of Cerebrovascular and Endovascular Neuros Vol.13 No.3
Objective : Elevation of serum S100B protein has been reported after cerebral ischemic strokes. Previous studies had revealed the positive correlation between peak concentration of serum S100B protein and extent of ischemic stroke. However its peak level usually reaches at 48~72 hours from stroke onset time. We evaluate the usefulness of serum S100B protein during hyperacute stage in the patients with ischemic stroke as a marker for expecting clinical severity and prognosis. Me thods : Total 67 patients who arrived in the Emergency Department within 6 hours from ischemic stroke onset were retrospectively recruited. Subjects were grouped according to the level of serum S100B protein (normal vs elevated group). We analyzed the differences of clinical (National Institute of Health Stroke Scale, NIHSS), laboratory (initial serum glucose, initial systolic blood pressure, lipid profiles, homocysteine) and radiologic (visible lesion in the initial MRI) data between those two groups. Results : Mean serum S100B protein was normal in 27patients and elevated in 40 patients. Infarction sizes, cortical lesions and level of serum triglyceride (TG) were significantly different between two groups. There were no significant differences in the age, sex, stroke etiology, initial NIHSS, initial serum glucose,blood pressure and other lipid profiles. Conclusion : Elevated serum S100B protein in the hyperacute phase of ischemic stroke was correlated with infarction extent, cortical involvement and lower serum TG level. Serum S100B protein may be used as an easily assessable and inexpensive marker for predicting infarction size and cortical involvement during hyperacute stage in patients with ischemic stroke regardless of other clinical factors.
Endovascular management of intracranial pseudoaneurysm: an institutional experience
Vivek Phogat,Ashok Gandhi,Trilochan Srivastava,Keshav Mishva 대한뇌혈관외과학회 2020 Journal of Cerebrovascular and Endovascular Neuros Vol.22 No.4
Objective: Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) and vertebral artery are rare entities but with varied treatment options. PSAs can be spontaneous or secondary to trauma, infections, malignancies or iatrogenic. To find out the efficacy of various endovascular interventions in the management of ICA and vertebral PSAs. Methods: The study included 14 patients diagnosed with intracranial PSAs who underwent endovascular interventions in SMS Medical College, Jaipur (Rajasthan) between June 2015 to January 2019. The clinical and radiological findings (computed tomography angiography and digital subtraction angiography) were reviewed and the consequent endovascular intervention carried out and their results were analyzed. Results: Total 14 patients were studied out of which 8 (57.1%) were anterior circulation PSAs and 6 (42.9%) were posterior circulation PSAs There were 10 (71.4%) females and 4 (28.5%) males between the age of 9 to 65 years. Only 2 patients with PSA had past history of trauma. Coiling was done in 8 patients (57.1%), stenting in 2 patients (14.2%), parent artery occlusion in 1 patient (7.1%), glue embolization in 1 patient (7.1%) while coiling with glue in 1 patient (7.1%) and flow diverter in 2 patients (14.2%). Immediate and complete occlusion was achieved in 11 (78.6%) patients while 3 (21.4%) patients had subtotal occlusion. 11 patients under follow up till June 2019 did not report recurrence or new neurological deficit. Conclusions: Endovascular interventions is minimally invasive and safe treatment strategy for intracranial PSAs. The ultimate choice of technique depends on clinical and imaging characteristics.
Woo Joo Lee,조준성 대한뇌혈관외과학회 2012 Journal of Cerebrovascular and Endovascular Neuros Vol.14 No.3
Use of stent assisted coiling of intracranial aneurysms has shown a recent increase. Despite technical improvement and accumulated clinical experiences, due to insufficient study data, debate over short and long term durability and associated complication has continued. To the best of our knowledge, this case report, for the first time, demonstrates delayed self-expansion phenomenon occurring as an acute and unpredictable complication of Neuroform stent assisted coiling for treatment of a ruptured intracranial aneurysm.
김재욱,남택균,박기수,박용숙,권정택 대한뇌혈관외과학회 2017 Journal of Cerebrovascular and Endovascular Neuros Vol.19 No.2
Unruptured cerebral aneurysms sometimes present with visual symptomsdue to compression of the visual pathways. However, until now, unruptured anterior communicating artery (ACoA) aneurysms presenting visual field defects have been extremely rare. The authors report the case of a 51-year-old woman who presented with left homonymous hemianopsia. Radiological findings demonstrated an ACoA aneurysm filled with thrombus, that was compressing the optic chiasm and post-chiasmal tract. The patient underwent clipping of the aneurysm, which resolved the visual field defect. In cases of visual field defects, an ACoA aneurysm should be included in the differential diagnosis.
Location and Characteristics of Warfarin Associated Intracranial Hemorrhage
이상민,박현석,최재형,허재택 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.3
Objective : In the so-called primary intracerebral hemorrhage (ICH), lobarand deep ICH were mainly due to cerebral amyloid angiopathy and deepperforating arterial disease. Our aim was to identify specifics of warfarinassociated ICH (WAICH) and to focus on differences in susceptibility towarfarin according to the underlying vasculopathies, expressed by ICHlocation. Materials and Methods : We identified all subjects aged ≥ 18 years whowere admitted with primary ICH between January 1, 2007 and September30, 2012. We retrospectively collected demographic characteristics, the presenceof vascular risk factors and pre-ICH medication by chart reviews. Wecategorized ICH into four types according to location: lobar, deep, posteriorfossa, and undetermined. We investigated characteristics (including hematomavolume and expansion) of ICH according to the location of ICH. Results : WAICH accounted for 35 patients (5.6%) of 622 ICH cases. InWAICH, 13 patients (37.1%) had lobar ICH and 22 patients (60.0%) hadnon-lobar ICH. Compared to other locations of ICH, lobar ICH showed anexcess risk of WAICH (OR 2.53, 95% CI 1.03-6.21, p = 0.042). The predictorsof lobar location of ICH were warfarin (OR 2.29, 95% CI 1.05-5.04, p =0.038) and diabetes mellitus (DM) (OR 0.54, 95% CI 0.29-0.98, p = 0.044). The lobar location of ICH showed significant association with larger hematomavolume (p = 0.001) and high ratio of hematoma expansion (p =0.037) compared with other locations of ICH. Conclusion : In our study, warfarin showed significant association with lobarICH and it caused larger hematoma volume and more expansion ofhematoma in lobar ICH.
Seby John,Syed Irteza Hussain,Bartlomiej Piechowski,Mohammad Asif Dogar 대한뇌혈관외과학회 2020 Journal of Cerebrovascular and Endovascular Neuros Vol.22 No.1
Objective: Mechanical thrombectomy (MT) is now an established treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO) within 6 hours. Since 2018, MT is also recommended from 6-24 hours after selecting with additional multimodal imaging including perfusion imaging. We sought to investigate patients with significant discrepancy in core infarct between computed tomography (CT) and CT perfusion (CTP). Methods: In this retrospective study, patients with AIS who were evaluated for MT using the RAPID software (IschemaView, Redwood City, CA, USA) from February 2018 to March 2019 were included. Cases with discrepancy between infarct volume on non-contrast CT and core volume (cerebral blood flow <30%) as analyzed by RAPID on CTP were analyzed. Results: In the study period, 635 patients were evaluated for acute stroke symptoms. Non-contrast head CT was performed in 635 patients, and CTP with RAPID software post processing was performed in 134 patients. Among the 134 patients, 8 (5.9%) patients had gross discrepancy in core infarct between CT and CTP, with underestimation of infarct by CTP. Evaluation of these cases shows that the likely reason for this discrepancy is recanalization of a LVO, which then leads to erroneously normal or gross underestimate of the core infarct volume determined from CTP post processing analysis. Conclusions: Recanalization of a LVO can lead to erroneously normal or gross underestimation of the core infarct as determined by post processing software analysis of CTP data. The whole composite of hyperacute CT imaging should be examined while making decisions. This caveat of perfusion imaging interpretation has not been reported previously.