Nylon Thread를 이용한 mouse 에서의 Transient middle cerebral artery occlusion (MCAO) model 확립

임병철,성지희,김하나,박승우 한국콘텐츠학회 2019 한국콘텐츠학회논문지 Vol.19 No.7

Introduction: In aged people, stroke incidence is increased. But standardized experimental animal protocol study for the research of stroke therapy is rare. There is little report on the success rate of cerebral artery occlusion model using standardized Nylon thread length of precise thread end-size controlled. Method: In this study, the operator intended the occlusion of middle cerebral artery (MCA) using 0.18±0.02mm end 5-0 Nylon thread. Middle cerebral artery occlusion was induced for 60min under isoflurane anesthesia. After 60min, the operator removed the Nylon thread and reperfusion was induced for 23hrs. The mice was killed 23hrs after reperfusion and infarction area of brain was confirmed by 1.5% TTC (2,3,5-tryphenyl tetrazolium chloride) staining. Results: According to end size and insert length of Nylon thread, Middle cerebral artery occlusion (n= 50), internal carotid artery occlusion (n= 14), distal middle cerebral artery occlusion (n= 36), anterior cerebral artery (n= 1) were induced. And no infarction (n= 50) was observed. Conclusion: According to weight of mice, the operator induced reversible cerebral artery occlusion model by different insert length (30.0~36.9g : 9.0mm, 37.0~40.0g : 9.5mm) of Nylon thread. Success of cerebral artery occlusion model was confirmed by checking infarction area using TTC staining. The success rate (66.9%, 101/151) of reversible cerebral artery occlusion model in the mouse and the operational conditions are shown. 서론: 최근 노년층에서 뇌졸중 발병률이 증가하고 있다. 현재 뇌졸중 치료제 및 방법이 많이 개발되어 있으나 치료 후에도 후유증 등이 많이 남게 된다. 그래서 아직도 많은 과학자나 임상 의사들이 이를 치료하기 위한 약물 및 방법을 연구하고 있는 실정이다. 많은 연구 중 뇌졸중 치료 연구를 위한 표준화된 실험 동물연구는 드물며, 표준화된 Nylon thread를 이용한 중대뇌동맥 폐쇄모델(MCAO, middle cerebral artery occlusion)의 성공률에 대한 연구는 거의 없다방법: 본연구는 0.18±0.02mm 의 지름을 가진 5-0 Nylon thread를 중대뇌동맥에 삽입하였다. 60분 동안 삽입한 후에 봉합해 놓았던 부위를 다시 절개하여 Nylon thread를 빼내고, 막았던 혈관의 매듭을 풀어주어, 다시 혈액이 공급되게 하였다. 그로부터 23시간 후에 뇌를 내어 1mm 두께로 자른 후 1.5% TTC (2',3',5'-triphenyl-tetrazolium chloride)로 15분간 염색하고, 4% PFA(paraformaldehyde)로 15분 동안 고정하였다. 결과: Nylon thread를 삽입하여, MCA occlusion 50마리, ICA occlusion 14마리, 제대로 된 MCAO model보다 좀 더 깊게 들어간 distal MCAO model 36마리, 너무 깊은 MCA나 ACA까지 들어가서 상보적인 괴사를 나타내는 occlusion model 1마리, 그리고 경색이 일어나지 않은 마우스 50마리를 확인하였다. 결론: 이에 본 연구에서는 Nylon Thread를 생쥐의 무게에 따라 32~36g 인 생쥐는 9mm로 삽입하여주고, 37~40g인 생쥐는 9mm+0.5mm의 깊이로 삽입하여서 1hr의 occlusion과 23hr의 reperfusion을 주어 생쥐를 TTC 염색을 통하여 괴사가 일어난 부분을 확인하였고, 생쥐에서 가역적인 뇌혈관 경색으로 151말중 101마리에서 뇌경색을 유도 할 수 있었다(66.9%).

급성망막동맥폐쇄 환자에서 동맥 내 혈전용해술 효과 : 임상 증례 및 문헌 고찰

조상일(Sang Il Cho),김준형(Joon Hyung Kim),조남천(Nam Chun Cho) 대한안과학회 2020 대한안과학회지 Vol.61 No.12

목적: 국내의 급성망막동맥폐쇄 환자들에게 동맥 내 혈전용해술을 6시간 이내에 시행하였고 그 효과에 대해서 외국의 증례와 비교하여 고찰해 보고자 한다. 대상과 방법: 2019년 6월부터 2019년 11월까지 본원에 급성망막동맥폐쇄로 내원한 5명의 환자에게 시력, 안압, 안저검사, 형광안저촬영을 시행 후 6시간 이내에 동맥 내 혈전용해술을 시행하였다. 이후 경과 관찰을 시행하며 시력 등의 예후를 확인하였다. 해외에서 동맥 내 혈전용해술을 시행한 6개의 연구들에서 연령, 성별, 시술 전후의 시력에 대하여 정리 및 비교하였다. 결과: 본원에서 시행한 5명의 연구에서 평균 연령은 63.4세였다. 남자가 3명, 여자가 2명이었으며 동맥 내 혈전용해술까지 걸린 평균시간은 4.8시간이었다. 시술 전 시력은 증례 1은 안전수동, 증례 2는 0.1, 증례 3은 안전수지 30 cm, 증례 4는 안전수동, 증례 5는 0.08이었다. 시술 후 시력은 증례 1은 0.9, 증례 2는 0.5, 증례 3은 안전수지 30 cm, 증례 4는 0.7, 증례 5는 1.2로 증례 3을 제외한 환자에서 모두 극적인 시력회복이 확인되었다. 해외에서 시행한 연구들의 평균 연령은 대부분 60세 이상이었다. 시술 전 시력은 대부분의 연구에서 빛 인지, 안전수동인 환자가 가장 많았다. 시술 후 시력은 전체에서는 경미한 회복(0.1 이하)이 가장 많았으나 세 가지 연구에서 부분적 회복(0.2-0.4)이상이 각각 65%, 32%, 43%를 보였다. 결론: 급성망막동맥폐쇄 환자가 발병 6시간 이내에 내원한 경우 동맥 내 혈전용해술을 시도해 볼 만하다. Purpose: We performed intra-arterial thrombolysis within 6 hours of presentation in Korean patients with acute retinal artery occlusion. The treatment outcomes of our patients were compared with those from a literature review of this procedure. Methods: Visual acuity, intraocular pressure, fundus photo, and fluorescein angiography were examined in five Korean patients who ultimately underwent intra-arterial thrombolysis due to central retinal artery occlusion. The visual acuity of patients was evaluated after the procedure. The treatment outcomes of our patients were compared with those presented in six foreign intra- arterial thrombolysis studies with respect to age, sex, and visual acuity before and after intra-arterial thrombolysis. Results: In our five cases (three males and two females), the average age was 63.4 years and the average time to the procedure of intra-arterial thrombolysis was 4.8 hours. In the five cases, the visual acuity before intra-arterial thrombolysis were hand movements, 0.1, finger counting at 30 cm, hand movements, and 0.08. Visual acuity after intra-arterial thrombolysis were 0.9, 0.5, finger counting at 30 cm, 0.7, and 1.2. The average age of patients in the six studies from the literature was 60 years, and the most common visual acuity before intra-arterial thrombolysis was light perception and hand movements. A slight improvement in visual acuity (>0 to 0.1) was common in most of the studies; however, three studies showed a partial recovery (from 0.2 to 0.4). Conclusions: For retinal artery occlusion, intra-arterial thrombolysis within 6 hours should be considered as a treatment option.

The Time Evolution of Cerebral Apoptosis in the Permanent Middle Cerebral Artery Occlusion Model in Rats

Shin, Cheol-Sik,Choi, Byung-Yon,Jung, Eul-Soo,Kim, Sang-Woo,Chang, Chul-Hoon,Cho, Soo-Ho The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.37 No.1

Objective: The purpose of this study is to determine the time evolution and distribution of cerebral apoptosis using the middle cerebral artery occlusion model in rats. Methods: A total of twenty four male rats - with 2, 3, 4, 6, 8, 12, 24 and 48 hours of middle cerebral artery occlusion respectively - were studied. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling(TUNEL) method was used for the observation of the apoptotic cells. The apoptotic ratio was calculated and the distribution of apoptosis was inspected in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex. The rats were divided into three groups(Group I : $2{\sim}4$ hours of occlusion, Group II : $6{\sim}$12 hours of occlusion, Group III : $24{\sim}48$ hours of occlusion). Results: In this study, the proportion of apoptosis increased with the duration of middle cerebral artery occlusion and reached a maximum after about 12 hours of middle cerebral artery occlusion. The mean values of the apoptotic ratio were $30.7{\pm}11.3%$ in group I, $60.8{\pm}2.6%$ in group II and $48.7{\pm}0.7%$ in group III. The distribution of apoptosis differed in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex according to the duration of time of the middle cerebral artery occlusion. Conclusion: In the middle cerebral artery occlusion model of the rats, apoptosis is found to increase according to the occlusion time, reaching a peak after 6 hours, and the distribution of apoptosis changed from the pyriform cortex to the basal ganglia and middle cerebral artery territory cortex.

Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

김용규,정철규,우세준,박규형 대한의학회 2015 Journal of Korean medical science Vol.30 No.12

Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HAinjected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.

만성 폐색성 동맥질환에서 발목 동맥압과 발목-팔동맥압 지수의 임상적 의미에 대한 고찰

남상협,이상오,이해완,류병윤,김홍기,최창식 大韓脈管外科學會 1995 大韓脈管外科學會誌 Vol.11 No.2

Left Subclavian Artery Occlusion: Femoro-Axillary Artery Retrograde Bypass

Masaya Nakashima,Hideaki Kobayashi,Masayoshi Kobayashi 대한혈관외과학회 2016 Vascular Specialist International Vol.32 No.2

The treatment tactics for subclavian artery occlusion include the more commonly used endovascular therapy rather than surgical intervention. We present a case of a 61-year-old woman with dialysis-dependent chronic renal failure who experienced left finger necrosis in the left upper extremity. To salvage the limb, we performed femoral-to-axillary (fem-ax) artery bypass using an autologous saphenous vein graft. However, 10 months later, she experienced coldness in the left forearm. Angiography revealed chronic total occlusion of the venous bypass. Despite emergent thrombectomy, redo fem-ax artery bypass operation was performed using a prosthetic graft. Upper limb salvage can be achieved by fem-ax artery retrograde bypass. The treatment tactics for subclavian artery occlusion include the more commonly used endovascular therapy rather than surgical intervention. We present a case of a 61-year-old woman with dialysis-dependent chronic renal failure who experienced left finger necrosis in the left upper extremity. To salvage the limb, we performed femoro-axillary (fem-ax) artery bypass using an autologous saphenous vein graft. However, 10 months later, she experienced coldness in the left forearm. Angiography revealed chronic total occlusion of the venous bypass. Despite emergent thrombectomy, redo fem-ax artery bypass operation was performed using a prosthetic graft. Upper limb salvage can be achieved by fem-ax artery retrograde bypass.

심근조영 심에코도를 이용한 관정맥동 중재시 심근관류양상 평가에 대한 연구

손대원 ( Son Dae Won ),박승우 ( Park Seung U ),김철호 ( Kim Cheol Ho ),오병희 ( O Byeong Hui ),이명묵 ( Lee Myeong Mug ),박영배 ( Park Yeong Bae ),최윤식 ( Choe Yun Sig ),서정돈 ( Seo Jeong Don ),이영우 ( Lee Yeong U ) 대한내과학회 1993 대한내과학회지 Vol.44 No.1

Background : During the past three decades there have been renewed interests in using the coronary sinus intervention to treat jeopardized myocardium. Mechanisms and effects of coronary sinus intervention have been studied by the techniques, application of which in vivo and in real time is not possible. Recently myocardial contrast echocardiography (MCE) has been shown to be able to offer unique capability of assessing the dynamic pattern of myocardial perfusion. Methods : MCE was perfomed in 7 open chest dogs with the intraaortic injection of hand-agitated contrast agent (hexabrix). Risk area and myocardial perfusion patterns were analized during coronary artery occlusion only, coronary artery occlusion with coronary sinus occlusion (CSO) and during rapid release of CSO. Also we observed myocardial perfusion pattern of coronary sinus retroperfusion during coronary artery occlusion. Results : 1) Myocardial contrast echocardiography did not change the hemodynamic parameters. 2) Ischemic risk area during coronary artery occlusion with CSO was significantly (p<0.05) smaller than that measured during coronary artery occlusion only. 3) Contrast washout was not enhanced during rapid release of coronary sinus occlusion compared to the basal status. So milking effect could not be demonstrated in this study. 4) During coronary artery occlusion, coronary sinus retroperfusion of contrast agent showed selective echo enhancement in ischemic risk area. Conclusion : Coronary sinus intervention is effective in reducing the ischemic risk area during coronary artery occlusion and its effect can be evaluated by MCE without significant hemodynamic changes.

Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

Kim, Yong-Kyu,Jung, Cheolkyu,Woo, Se Joon,Park, Kyu Hyung The Korean Academy of Medical Sciences 2015 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.30 No.12

<P>Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.</P>

급성 말초 동맥 폐색증의 치료

박형준,박연고,고영환,서태석,이운기,박홍규,백정흠,이정남,정민,이영돈,민승기 대한혈관외과학회 2003 Vascular Specialist International Vol.19 No.1

Role of the Peripheral Vestibular End Organ in the Expression of c-Fos Protein in the Medial Vestibular Nucleus Following Occlusion of the Anterior Inferior Cerebellar Artery

김나리,이재희,최명애,박병건,김민선,박병림 대한평형의학회 2012 Research in Vestibular Science Vol.11 No.2

Background and Objectives: The present study investigated the role of the peripheral vestibular end organ in vestibular symptoms and temporal changes in expression of c-Fos protein in the vestibular nuclei following anterior inferior cerebellar artery (AICA) occlusion using rats with unilateral or bilateral labyrinthectomy. Materials and Methods: Expression of c-Fos protein in the vestibular nuclei was measured 2,12, 24, and 48 hours after AICA occlusion. Results: Unilateral AICA occlusion significantly induced expression of c-Fos protein bilaterally in the medial, inferior,superior, and lateral vestibular nuclei. Following AICA occlusion, the medial vestibular nucleus (MVN) showed the highest expression of c-Fos protein among the 4 vestibular nuclei. The expression of c-Fos protein was asymmetric between the bilateral MVN, showing higher expression in the MVN contralateral to the side of AICA occlusion compared to the ipsilateral MVN. The degree of asymmetry in c-Fos protein expression between the bilateral MVN peaked 12 hours after AICA occlusion. The expression of c-Fos protein gradually decreased 24 hours after AICA occlusion and returned to control levels 48 hours after AICA occlusion. Unilateral labyrinthectomy significantly decreased expression of c-Fos protein in the MVN ipsilateral to the side of labyrinthectomy following AICA occlusion. Moreover,bilateral labyrinthectomy significantly decreased expression of c-Fos protein in the bilateral MVN flowing AICA occlusion. Conclusion: These results suggest that afferent signals from the peripheral vestibular end organ are crucial to the expression of c-Fos protein in the MVN following AICA occlusion and that expression of c-Fos protein is sustained for 24 hours after AICA occlusion.