혈관 조영술을 이용한 관동맥,말초혈관,경동맥의 동맥경화성 협착병변의 빈도

최동훈,편욱범,윤영섭,장양수,심원흠 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.9

경동맥에서 기원한 혈관종에서 발생한 자연 출혈 1예

조상혁,김성운,김희경,이승원 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.9

There are various reasons as to why the carotid artery ruptures, which is a life-threatening problem. Although several specific conditions may predispose the carotid artery to rupture, spontaneous carotid bleeding from hemangioma rupture originateing from the carotid artery wall is extremely rare. We present a case of a 56-year-old male, with a massive neck swelling without any causes. Contrast enhanced computed tomography revealed a massive hematoma in the region of the left level II, III and linear enhancement leakage from the left common carotid artery. During the emergent neck exploration, we found a few centimeters of reddish mass on the lower part of the carotid bifurcation following massive hematoma removal. This mass is the origin of the massive bleeding and we carefully dissected the mass from the carotid artery without causing any severe bleeding or other complications. The pathologic report revealed that the carotid mass is hemangioma that originates from the carotid artery wall (tunica adventitia). We report, with a literature reviews, this extremely rare case of spontaneous hemorrhage from hemangioma rupture from the carotid artery wall.

경동맥 절제후 혈관치환술을 시행한 경동맥체 종양

최건,이은수,정광윤,최종욱,Choi, Geon,Lee, Eun-Soo,Jung, Kwang-Yoon,Choi, Jong-Ouck 대한기관식도과학회 1996 大韓氣管食道科學會誌 Vol.2 No.2

Carotid body tumors are uncommon tumors of the head and neck Surgery is the primary treatment for the tumor. Large carotid body tumors frequently encircle the common, internal, and exernal carotid arteries, and extensive bleeding often complicates the resection, increasing the risk of carotid artery rupture and damange to major cranial nerves. Grafting should be used in high-risk patients. We have experienced a case of carotid body tumor which encircle the common, internal and external carotid arteries, treated with ligation of external carotid artery and grafting using Gortex between common carotid artery and internal carotid artery.

파노라마방사선사진에서 석회화가 발견되는 경동맥의 협착 정도

조소양,오원만,윤숙자,윤웅,이재서,Juan M. Palomo,강병철 대한구강악안면방사선학회 2009 Imaging Science in Dentistry Vol.39 No.3

Purpose : This study aimed to investigate the luminal stenosis of the internal carotid artery with calcification detected on panoramic radiographs. Materials and Methods : This study used fifty carotid arteries of 36 dental patients whose panoramic radiograph and computed tomography angiography (CTA) revealed the presence of carotid artery calcification. A neuroradiologist interpreted CTA to determine the degree of stenosis of the internal carotid arteries. The degree of stenosis was stratified in four stages; normal (no stenosis), mild stenosis (1-49%), moderate stenosis (50-69%) and severe stenosis (70-99%). Results : Among the fifty carotid arteries with calcification detected on both panoramic radiography and CTA, 20 carotid arteries (40%) were normal, 29 carotid arteries (18%) had mild stenosis, 1 carotid artery (2%) had moderate stenosis, and there was none with severe stenosis. Conclusion : Sixty percent of the carotid arteries with calcification detected on both panoramic radiography and CTA had internal luminal stenosis, and two percent had moderate stenosis. When carotid atheroma is detected on panoramic radiograph, it is possible that the dental patient has luminal stenosis of the internal carotid artery. (Korean J Oral Maxillofac Radiol 2009; 39 : 157-61)

Treatment results of carotid endarterectomy and carotid artery stenting for patients with radiation-induced carotid stenosis

Jihee Kang,Shin-Young Woo,Shin-Seok Yang,Yang-Jin Park,Dong-Ik Kim,Pyoung Jeon,Gyeong-Moon Kim,Young-Wook Kim 대한외과학회 2022 Annals of Surgical Treatment and Research(ASRT) Vol.103 No.2

Purpose: Exposure to ionizing radiation over the head and neck accelerates atherosclerotic changes in the carotid arteries. Owing to the characteristics of radiation-induced carotid stenosis (RICS), the results regarding the optimal revascularization method for RICS vary. This study compared treatment outcomes between carotid endarterectomy (CEA) and carotid artery stenting (CAS) in RICS. Methods: This was a single-center retrospective review of consecutive patients who underwent CEA or CAS for carotid stenosis. RICS was defined as carotid stenosis (>50%) with the prior neck irradiation for cancer treatment on either side. For the analyses, demographics, comorbid conditions, carotid lesion characteristics based on imaging studies, surgical complications, neurologic outcomes, and mortality during the follow-up period were reviewed. To compare CEA and CAS results in RICS, a 1:1 propensity score matching was applied. Results: Between November 1994 and June 2021, 43 patients with RICS and 2,407 patients with non-RICS underwent carotid revascularization with CEA or CAS. RICS had fewer atherosclerotic risk factors and more frequent severe carotid stenosis and contralateral carotid occlusions than non-RICS. CAS was more commonly performed than CEA (22.9% . 77.1%) for RICS due to more frequent unfavorable carotid anatomy (0 . 16.2%). Procedure-related complications were more common in the CEA than in the CAS. However, there was no significant difference in neurologic outcomes and restenosis rates between CEA and CAS in RICS. Conclusion: Considering its lesion characteristics and cumulative incidence, RICS requires more attention than non-RICS. Although CAS has broader indications for RICS, CEA has shown acceptable results if selectively performed.

안정형 협심증과 급성 관상동맥 증후군 환자에서 경동맥의 재형성

박정랑 ( Jeong Rang Park ),권태정 ( Tae Jung Kwon ),강영란 ( Young Ran Kang ),박소라 ( So Ra Park ),고진신 ( Jin Sin Kho ),임성일 ( Sung Il Im ),박성지 ( Sung Ji Park ),곽충환 ( Chung Hwan Kwak ),황진용 ( Jin Yong Hwang ) 대한내과학회 2006 대한내과학회지 Vol.71 No.3

목적: 불안정하고 염증이 활발한 동맥경화반에서는 보상적인 혈관의 양성 재형성이 일어난다. 급성 관상동맥 증후군 환자에서 일어나는 관상동맥의 양성 혈관재형성이 전신적 염증반응에 의해 경동맥의 혈관 재형성에도 영향을 미칠 것이라는 것을 유추해 볼 수 있다. 이에 저자는 급성 관상동맥 증후군과 만성 안정형 협심증환자에서 경동맥과 상지동맥구조의 차이를 관찰하여 급성 관상동맥 증후군에서 발생하는 관상동맥의 염증으로 인한 혈관재형성이 총경동맥에서도 발생하는가를 알아 보고자 본 연구를 시행하였다. 방법: 급성 관상동맥 증후군 74명과 안정형 협심증 31명을 대상으로 B-mode 초음파 검사를 사용하여 양측 총경동맥의 IMT, LD, IAD를 측정하였다. 양성재형성 은 IMT>1 mm이면서 IAD>8 mm인 경우, 음성재형성은 IMT>1 mm이고 IAD<7 mm일 때, 그 외의 경우를 무재형성이라 정의하여 비교하였다. 결과: 급성 관상동맥 증후군과 안정형 협심증 양 군에서 IMTmax, LD, IAD는 차이가 없었고, 우총경동맥과 좌총경동맥 각각의 양성재형성, 음성재형성, 무재형성 또한 차이가 없었다. 양 총경동맥의 동맥경화반의 존재유무, 동맥경화반의 특징의 비교에도 두 군의 차이는 없었다. 총경동맥의 재형성지표인 IAD/LD는 IMTmax와 의미있는 상관관계를 보였다(우총경동맥의 IMTmax과 IAD/LD의 상관계수 r=0.797 p<0.001, 좌총경동맥의 IMTmax와 IAD/LD의 상관계수 r=0.860, p<0.001).결론: 급성 관상동맥 증후군 환자와 안정형 협심증 환자를 비교했을 때 총경동맥의 특징에 차이가 없었다. 따라서 혈관의 재형성 과정은 급성 관상동맥 증후군과 같은 전신적인 염증에 의해 진행되는 전신적인 변화보다 주로 국소적인 혈역학적 인자가 더 중요하게 관여하는 것으로 생각되어지며 더 많은 환자에서의 연구가 진행되어야 할 것으로 생각된다. Background: Acute adaptive vascular remodeling occurs in active and unstable inflammatory plaques. It has been suggested that the adaptive coronary vascular remodeling, in patients with acute coronary syndrome (ACS), may be systemic and may show similar vascular remodeling in the carotid arteries. We investigated the ultrasonographic features of the common carotid artery (CCA) to determine whether the arterial expansive remodeling found in the coronary artery occurs in the carotid arteries of patients with ACS. Methods: We measured lumen diameter (LD), interadventitial diameter (IAD) and intima media thickness (IMT) using a B-mode ultrasound in both common carotid arteries in patients with ACS (N=74) and chronic stable angina (CSA) (N=31). Positive remodeling was arbitrarily defined as an IMTmax>1 mm and IAD>8 mm and negative remodeling as an IMTmax>1 mm and IAD<7 mm. Other values were defined as no remodeling. Results: There were no significant differences in LD IAD and maximal IMT of the right CCA and the left CCA in comparisons between the ACS and the CSA patient groups. There were no differences for number of cases with no remodeling or differences in positive and negative remodeling in the right common carotid artery and left common carotid artery in comparisons between the ACS and CSA patient groups. . Presence of plaque in both common carotid arteries showed similar frequency in the ACS and CSA patient groups. The characteristics of carotid artery plaques were not different in the two groups. The remodeling index (IAD/LD) was correlated with IMTmax (right CCA r=0.797, p<0.001; left CCA r=0.860, p<0.001). Conclusions: The common carotid arterial structure of ACS patients was not different from that of CSA patients. Therefore, these results suggest that the expansive arterial remodeling, due to coronary inflammatory plaques, appears to take place locally rather than systemically.(Korean J Med 71:266-275, 2006)

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

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.

다발성 경동맥 폐색성 질환으로 인한 뇌허혈증 환자에서 쇄골하동맥-내경동맥 문합술 및 경동맥 내막 절제술을 이용한 단계적 외과적 치료 : 증례보고 Case Report

류권의,신용삼,김선호,이규창 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.3

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.