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.

한국에서 경동맥 협착증 관련 건강상태별 삶의 질 조사

박지정,오성희,유지혜,이자연,신상진 한국보건의료기술평가학회 2016 보건의료기술평가 Vol.4 No.1

Objectives: This study was carried out to investigate the impact of carotid artery stenosis on qualify of life in Korea. Methods: A health scenario for each health states after undergoing carotid endar- terectomy or carotid artery stent was developed, and Time Trade Off and EQ-5D-3L tools were used on 400 general population to examine health-related quality of life. In addition, the 5th Korea Na- tional Health and Nutrition Examination Survey (2012) and Stoke Registry of Seoul National Uni- versity Bundang Hospital were utilized to find out quality of life of stroke and myocardial infarction, which are major complications of carotid artery stenosis. Results: As a result of survey, utility weight for health states without major complications after undergoing carotid endarterectomy or carotid artery stent to treat carotid artery stenosis was 0.79 (±0.10), and utility weight was further decreased to 0.61 (±0.13) for health states after undergoing reoperation due to restenosis. These weight were similar to major complications, which showed utility of 0.77 (±0.05) for myocardial infarction and 0.79 (±0.06) for minor stroke. They were higher than weight of 0.41 (±0.48) for major stroke. Con- clusion: The results of this study showed that quality of life of carotid artery stenosis is similar to myocardial infarction and minor stroke. The meaning of this study is in that it produced Korean utility weight of each health states related to carotid artery stenosis which are regarded as critical data re- quired for cost-utility analysis in the future.

A Protocol-Based Decision for Choosing a Proper Surgical Treatment Option for Carotid Artery Stenosis

장이욱,이경열,정준호,Kwon-Duk Seo,서상현,김용배 대한뇌혈관외과학회 2015 Journal of Cerebrovascular and Endovascular Neuros Vol.17 No.2

Objective:There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. Materials and Methods:A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. Results:CEA or CAS is indicated when the patient has a symptomatic stenosis ≥ 50%, or when the patient has an asymptomatic stenosis ≥ 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. Conclusion:We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.

Carotid Artery Stenting for Asymptomatic Carotid Stenosis: What We Need to Know for Treatment Decision

Baek Jang-Hyun 대한신경중재치료의학회 2023 Neurointervention Vol.18 No.1

A clinical decision on the treatment of asymptomatic carotid stenosis is challenging, unlike symptomatic carotid stenosis. Carotid artery stenting (CAS) has been recommended as an alternative to carotid endarterectomy (CEA) based on the finding that the efficacy and safety of CAS were comparable to CEA in randomized trials. However, in some countries, CAS is often performed more frequently than CEA for asymptomatic carotid stenosis. Moreover, it has been recently reported that CAS is not superior to the best medical treatment in asymptomatic carotid stenosis. Due to these recent changes, the role of CAS in asymptomatic carotid stenosis should be revisited. When determining the treatment for asymptomatic carotid stenosis, one should consider several clinical factors including stenosis degree, patient life expectancy, stroke risk by medical treatment, availability of a vascular surgeon, high risk for CEA or CAS, and insurance coverage. This review aimed to present and pragmatically organize the information that is necessary for a clinical decision on CAS in asymptomatic carotid stenosis. In conclusion, although the traditional benefit of CAS is being revisited recently, it seems too early to conclude that CAS is no longer beneficial under intense and systemic medical treatment. Instead, a treatment strategy with CAS should evolve to select eligible or medically high-risk patients more precisely.

경동맥 협착을 동반한 관상동맥 질환의 수술적 치료 -2례 보고-

이창하 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.9

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.

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.

두개외 경동맥 협착증에 대한 스텐트 삽입술의 추적 결과

윤영섭,홍범기,최동훈,김선호,김동익,김승민,장양수,심원흠 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.11

경동맥 초음파를 이용한 뇌경색 환자의 내경동맥 협착도와 습담변증(濕痰辨證)의 관련성 연구

박수경,곽승혁,우수경,이은찬,박주영,정우상,문상관,조기호,박성욱,고창남,Park, Su-kyung,Kwak, Seung-hyuk,Woo, Su-kyung,Lee, Eun-chan,Park, Joo-young,Jung, Woo-sang,Moon, Sang-kwan,Cho, Ki-ho,Park, Sung-wook,Ko, Chang-nam 대한중풍순환신경학회 2011 대한중풍.순환신경학회지 Vol.12 No.1

Objectives : This study was aimed to clarify the relationship between the dampness-phlegm diagnosis and internal carotid artery stenosis by measuring carotid artery sonography in cerebral infarction patients. Methods : One hundred eighty subjects were recruited from the patients admitted to the Department of Internal Medicine at Kyunghee university oriental medical center from September 2008 to July 2010. We assessed one hundred eighty patients' carotid artery sonography data and diagnosed dampness-phlegm by oriental medical diagnosis. then, analyzed their characteristics, risk factor, lifestyle, metabolic syndrome, body mass index, Waist/Hip ratio(W/H ratio) and dampness-phlegm diagnosis. Results : On the demographic variables of the patients, age, smoking, W/H ratio and dampness-phlegm group were significantly higher in severe internal carotid artery(ICA) stenosis group than in the control group. According to the significant difference in dampness-phlegm group, we analyzed dampness-phlegm related index for pattern identifications by ICA stenosis. As a result, sputum, bowel sound, chest discomfort, slippery pulse were significantly higher in the severe ICA stenosis group than in the control group. In multivariate analysis, dampness-phlegm group showed close relationship with severe ICA stenosis group. Conclusion : According to the analysis, significance between dampness-phlegm diagnosed patients group and severe ICA stenosis were clarified. These results can be utilized in the future as a basis material.

Carotid artery stenting

박재형,이재환 대한심장학회 2018 Korean Circulation Journal Vol.48 No.2

Carotid artery stenosis is relatively common and is a significant cause of ischemic stroke, but carotid revascularization can reduce the risk of ischemic stroke in patients with significant symptomatic stenosis. Carotid endarterectomy has been and remains the gold standard treatment to reduce the risk of carotid artery stenosis. Carotid artery stenting (CAS) (or carotid artery stent implantation) is another method of carotid revascularization, which has developed rapidly over the last 30 years. To date, the frequency of use of CAS is increasing, and clinical outcomes are improving with technical advancements. However, the value of CAS remains unclear in patients with significant carotid artery stenosis. This review article discusses the basic concepts and procedural techniques involved in CAS