안허혈 증후군의 임상 양상 및 치료

양지욱(Ji-Wook Yang),정진(Jin Chung),박영훈(Young-Hoon Park) 대한검안학회 2011 Annals of optometry and contact lens Vol.10 No.1

목적: 안허혈 증후군 환자들의 임상 양상과 동반된 전신 질환을 분석하고 속목동맥(internal carotid artery) 협착 정도에 따른 시력 예후 및 임상 증상의 차이에 대해 알아보고자 하였다. 대상과 방법: 안허혈 증후군으로 진단된 11명(11안)의 의무 기록을 후향적으로 검토하여 세극등현미경검사 및 형광안저혈관조영술을 포함한 안과 검사와 자기공명혈관조영술, 목동맥초음파촬영술 또는 목동맥혈관조영술을 통해 시력, 홍채신생혈관 유무, 안압, 백내장 정도 및 속목동맥의 협착 정도를 조사하였고 뇌혈관 질환과 당뇨병, 고혈압, 심장 질환 등 전신 질환 유무도 확인하였다. 결과: 11명(11안)의 환자들의 평균 연령은 50.8세였다. 속목동맥 협착이 심할수록 최종 시력 예후가 더 나빴으며(p<0.01), 백내장이 관찰된 4안 중 3안(75%)에서 안허혈이 발생한 쪽에서 반대쪽과 비교하여 백내장의 발생과 진행이 더 심하였다. 4명(36.4%)의 환자에서 뇌혈관 질환의 병력이 있었고. 2명(18.2%)의 환자에서 심장 질환이 있었으며, 4명(36.4%)에서 당뇨, 5명(45.4%)에서 고혈압이 관찰되었다. 급성으로 발병한 1예에서 목동맥혈관조영술 시행 중에 속목동맥을 통한 우로키나아제(urokinase) 주입술로 0.04에서 1.0으로 시력이 호전되었다. 결론: 안허혈 증후군의 소견이 보일 때는 속목동맥에 대한 검사를 요하며 속목동맥의 협착이 심할수록 최종 시력 예후는 불량하였다. 안허혈이 발생한 눈에서 백내장 발생 및 진행이 더 심하였으며 속목동맥을 통한 항응고제 치료도 고려될 수 있다. Purpose: To evaluate the clinical manifestations and the systemic diseases of ocular ischemic syndrome and the relationship between the stenosis of internal carotid artery and the visual prognosis. Methods: We retrospectively reviewed the medical records of 11 ocular ischemic syndrome patients. By ocular examinations including slit lamp examination and fluorescein angiography, magnetic resonance angiography, carotid artery ultrasonography and trans-femoral carotid angiogram, we investigated visual acuity, new vessels at iris, intraocular pressures, grades of cataract and stenosis of internal carotid artery. Also we investigated the persences of cerebrovascular diseas, diabetes mellitus, hypertension, ischemic heart disease and other systemic disorders. Results: The average age of 11 patients was 50.8 years old. The final visual prognosis became poorer in proportion to the stenosis of internal carotid artery (p<0.01), there were more severe grades of cataract in the eyes which had ocular ischemic syndrome compared with unaffected eyes. 4 patients (36.4%) had cerebrovascular attack, 2 patients (18.2%) ischemic heart disease, 4 patients (36.4%) diabetes mellitus and 5 patients (45.4%) hypertention. In one case which had ocular ischemic syndrome acutely, visual acuity improved 0.04 initially to 1.0 after urokinase injection through internal carotid artery. Conclusions: When the clinical symptoms of ocular ischemic syndrome were shown, the examinations into internal carotid artery should be necessary. The final visual prognosis became poorer in proportion to the stenosis of internal carotid artery and there were more severe grades of cataract in the eyes which had ocular ischemic syndrome compared with unaffected eyes. And if ophthalmologist diagnosed ocular ischemic syndrome, anticoagulant therapy through internal carotid artery could be considered.

뇌동맥류를 동반한 양측내경동맥 저형성증 : 증례보고 Report of Two Cases

정호,안용붕,이상걸,박문선 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.1

Bilateral hypoplasia of the internal carotid arteries is a rare condition. The authors experienced two cases of bilateral hypoplasia of the internal carotid arteries. In one case a 46-year-old female patient presented with subarachnoid hemorrhage Internal carotid angiograms showed right hypoplastic internal carotid artery and left agenetic internal carotid artery. An aneurysm believed to he the source of the subarachnoid hemorrhage, took origin from the trunk of the basilar artery. In another case a 48-year-old male, presented with semicomatous mentality. Brain CT demonstrated intracranial hemorrhage on the parasylvian area, and high density on the basal cistern, quadrigeminal cistern and temporal horn of left lateral ventricle. Initially aortic arch injection did not visualized the origin of the common carotid arteries. It revealed only the vertebral arteries and both external carotid artery originating from each vertebral artery. A selective left vetebral artery study demonstrated a communication between the hypertrophied basilar artery and the posterior cerebral arteries. The anterior and middle cerebral vessels, in turn, were opacified through the circle of Wiliis. via the posterior communicating arteries. In addition, an aneurysm, believed to be the sourse of the subarachnoid hemorrhage took origin from the posterior cerebral artery. The cases of the bilateral hypoplasia of internal carotid artery with intracranial aneurysm are reported as above, together with literature review.

내경동맥에서 분지된 구상돌기동맥에 발생한 동맥류 : 증례보고 Cases report

권순찬,박상근,권점대,신형식,김상진 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.8

Is the retrograde access for endovascular treatment of a traumatic carotid cavernous fistula associated with dissection of the ipsilateral carotid possible?

Pagiola Igor,Amaral Bruno,Saito Celso,Nalli Darcio,Junior Henrique Carrete,Frudit Michel 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.1

This is a case demonstrating a combined traumatic lesion of the internal carotid artery (dissection and a carotid cavernous fistula [CCF]) in a patient who was beaten during a robbery and, while trying to escape, was hit by a vehicle. Endovascular approach for the treatment was chosen using the retrograde access from the vertebral artery to the cavernous sinus by posterior communicating (Pcom) artery due to the occlusion of the ipsilateral internal carotid. Because the artery access by the internal carotid was impossible, retrograde approach by vertebral artery and Pcom artery was done to treat the direct CCF. A patient presented with left hemiplegia and proptosis, chemosis, right eye ptosis. Computed tomography (CT) and CT angiography revealed a CCF of the right carotid. An arterial retrograde endovascular approach by the vertebral artery was used for CCF occlusion with coils. We present a rare case of a combined traumatic cerebrovascular lesion, right carotid artery dissection and a right direct CCF treated by a retrograde endovascular approach by the vertebral artery through the Pcom artery to reach the fistula point and achieved a complete cure of the CCF

눈운동장애 없이 시력 저하를 보인 해면정맥동 내경동맥류 1예

김승훈,김선웅,김범태,장지호,Seung Hoon Kim,Sun Woong Kim,Bum-Tae Kim,Jee Ho Chang 대한안과학회 2012 대한안과학회지 Vol.53 No.3

Purpose: Oculomotor disturbance is the common manifestation of intracavernous carotid aneurysm cases. Intracavernous carotid aneurysms causing compressive optic neuropathy with no oculomotor disturbance are relatively rare due to their anatomical characteristics. We experienced a case of intracavernous carotid aneurysm which resulted in a shifted supraclinoid segment of the internal carotid artery, presenting with visual loss and visual field defect with no oculomotor disturbance. Case summary: A 40-year-old woman presented with loss of vision in the right eye. A relative afferent pupillary defect was observed in this eye. Visual field test showed quadranopsia in the right eye. Magnetic resonance imaging revealed that the intracavernous carotid aneurysm had shifted the supraclinoid segment of the internal carotid artery to the superomedial position. The right optic nerve was directly molded by the shifted supraclinoid segment of the internal carotid artery at the point of the bifurcation between the anterior cerebral artery and the middle cerebral artery. A Guglielmi detachable coil (GDC) embolization was performed successfully with no operational complications. Six months after coiling, best corrected visual acuity of the right eye was 1.0, and the visual field defect had recovered in all except the superior temporal field. Conclusions: Oculomotor disturbance is frequently associated with intracavernous carotid aneurysms. Nevertheless, optic neuropathy without oculomotor disturbance may be the only sign in patients with an intracavernous carotid aneurysm that causes shifting of the supraclinoid segment of the internal carotid artery. J Korean Ophthalmol Soc 2012;53(3):486-491

내경동맥의 발육부전을 동반한 뇌동맥류

이장철,임만빈,김동원,이정교,김인홍 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.4

The authors report two cases of intracranial aneurysm associated with aplasia of internal carotid artery. The one case showed complete occlusion of left internal carotid artery just above the origin of ophthalmic artery and aneurysm which located at the junction of basilar superior cerebellar artery. The blood supply of the left side anterior cerebral artery came from the right carotid artery through the anterior communicating artery and the left middle cerebral artery came from basilar artery through the enlarged posterior communicating artery. The another case showed marked narrow cervical portion of right internal carotid artery which terminated as a posterior communicating artery just above the origin of ophthalmic artery and large aneurysm which located at the anterior communicating artery. The blood supply of the right side of anterior cerebral and middle cerebral artery came from the left internal carotid artery through the anterior communicating artery. We tried to surgical management of these two aneurysms. We reviewed the literature and discussed the related collateral circulation of this anomaly.

Continued Lodging of Retinal Emboli in a Patient with Internal Carotid Artery and Ophthalmic Artery Occlusions

In Taek Kim,Sung Kyu Park,Sam Do Shim 대한안과학회 1999 Korean Journal of Ophthalmology Vol.13 No.1

Internal carotid artery or ophthalmic artery occlusions are devastating ophthalmological events which lead to severe impairment of vision. A case of multiple branch retinal artery occlusions in a 63-year-old male with internal carotid artery and ophthalmic artery occlusions on brain angiography is presented. Emboli lodging in branches of the retinal arteries were bright, glistening, yellow or orange in appearance. Such a distinctive ophthalmoscopic appearance led to the diagnosis of cholesterol emboli. Fluorescein and indocyanine green angiography disclosed delayed filling of the retinal vessels and choroid, and showed multiple hypofluorescence distal to the vessels in which the emboli were lodged. At the time of initial examination, the number of emboli lodged in retinal arteries was estimated at more than 20. As time passed, a few of the previous emboli disappeared and new emboli appeared in other sites on fundus examination. We think that the lodging of new emboli in other sites is due to the continued break-up of atheromatous tissue through the collateral circulation associated with the occlusion of the internal carotid and ophthalmic arteries.

Combined Anatomical Anomalies of Direct Aortic Arch Origins of the Left Internal Carotid, Left External Carotid, and Left Vertebral Arteries: A Case Report

Dae Yun Park,Byunghoon Lee,Yoon Joon Hwang 대한영상의학회 2023 대한영상의학회지 Vol.84 No.1

Various branch anomalies of the aortic arch have been reported, but cases with separate origins of the internal and external carotid arteries with combined direct aortic arch origin of the left vertebral artery are extremely rare. Herein, we present a rare case of aplasia of the left common carotid artery with separate origins of the ipsilateral internal and external carotid arteries and vertebral artery from the aortic arch in a 10-year-old girl. In addition, we review the embryological development and clinical implications of these anatomical variations.

External Carotid Artery Angioplasty and Stenting Followed by Superficial Temporal Artery to Middle Cerebral Artery Anastomosis

Ko, Jun-Kyeung,Lee, Sang-Weon,Lee, Tae-Hong,Choi, Chang-Hwa The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.46 No.5

A 31-year-old man presented with right hemiparesis, and magnetic resonance imaging revealed a small infarct at left basal ganglia. Digital subtraction angiography showed left cervical internal carotid artery (ICA) occlusion and severe stenosis of the ipsilateral external carotid artery (ECA) with collateral cerebral circulation fed by ECAs. Based on the results of a functional evaluation of cerebral blood flow, we performed preventive ECA angioplasty and stenting for advanced ECA stenosis to ensure sufficient blood flow to the superficial temporal artery. Eight weeks later, superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was performed. His postoperative course was uneventful and no additional transient ischemic attacks have occurred. To our knowledge, this is the first report of preventive angioplasty and stenting for advanced narrowing of an ECA before STA-MCA anastomosis for ipsilateral ICA occlusion.

Coexistence of the Absence of the Left Common Carotid Artery, a Common Origin of the Left External Carotid Artery and the Right Common Carotid Artery, and an Aberrant Right Subclavian Artery: A Case Report

이수정,최혜정,김상흠 대한영상의학회 2021 대한영상의학회지 Vol.82 No.4

The absence of the common carotid artery (CCA) and the common origin of the left external carotid artery (ECA) and the right CCA are rare anomalies of the cervical vascular system. We report here a case involving the coexistence of these vascular anomalies with an aberrant right subclavian artery, which is a common congenital anomaly in the aortic arch, and review the embryologic mechanism and clinical importance of this case.