경중맥을 통한 오른쪽 속목동맥 협착증 환자에서의 스텐트 삽입술 1례

강웅철,윤영섭,최동훈,심원흠 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8

심전도에 의한 넓은 QRS 빈맥의 감별 진단

강웅철,안신기,이문형,김성순 대한순환기학회 2003 Korean Circulation Journal Vol.33 No.3

급성 심근경색증 환자에서 Heparin-Coated 스텐트를 이용한 일차적 관동맥 중재술의 장기 성적.

강웅철,한승환,안태훈,손민수,손지원,신익균 대한심장학회 2004 Korean Circulation Journal Vol.34 No.6

Background and Objectives:Primary percutaneous coronary intervention (PCI) has been reported to be effectivereperfusion therapy for acute myocardial infarction (AMI). In the very thrombotic environment ofAMI, primary PCI, with heparin-coated stents, has been known to reduce the early reocclusion of the stentedvessel by preventing thrombosis. However, little data exist regarding the long-term clinical outcomes. Theaim of our study was to evaluate the safety, feasibility and long-term efficacy of heparin-coated stents inAMI. Subjects and Methods:Between January 1998 and July 2002, primary PCI with heparin-coated stentswas performed in 132 consecutive patients (98 males, with a mean age of 56.3±10.7 years) admitted with thediagnosis of AMI within 12 hours from the onset of the chest pain. Major adverse cardiac events (MACE),including death, MI, TLR (target lesion revascularization) and CABG, were recorded during hospitalizationand the follow-up period. Angiograms were obtained at the baseline, after stent implantation and at 6 monthsfollowing implantation. Results:The angiographic and procedure success rate was 96.2%. During hospitalization,there was no evidence of reocclusion of stented vessel, but 1 patient underwent a repeat PCI due todissection. There were no bleeding complications. A six-month angiographic follow-up was completed in47.2% of eligible patients and binary restenosis was present in 20.1%. During the long-term clinical followup(mean follow-up period 37.2±17.2 months), there were 12 deaths, 1 myocardial infarction and 18 TLR. TheMACE free survival rate was 76.5%. Conclusion:Primary PCI, with heparin-coated stents, shows favorablelong-term clinical outcomes. 배경 및 목적:급성 심근경색증 환자의 일차적 관동맥 중재술에서 스텐트 시술은 풍선도자만을 이용하는 경우에 비해 재협착율이 낮고 임상적인 성적이 나은 것으로 보고 되고 있다.급성 심근경색증에서와 같이 혈전형성이 쉬운 환경에서heparin-coated 스텐트는 시술 후 초기에 혈전 생성을억제함으로써 혈전에 의한 조기 재폐쇄 예방에 효과적인것으로 알려져 있으나 이에 대한 장기적인 결과는 잘 알려져 있지 않다.방 법:1998년 1월부터 2002년 7월 사이 급성 심근경색으로 스텐트를 이용해 일차적 관동맥 중재술을 시행 받았고 1년 이상 추적관찰이 가능했던 132명의 환자(남자:98명, 평균연령:56.3±10.7세)를 대상으로 관동맥 조영술 소견 및 임상 성적을 후향적으로 분석하였다.결 과: 흉통 발생 후 재관류까지의 평균 시간은 254.0±129.0 분이었다. 경색관련동맥의 분포는 좌전행지 65병변(49.2%), 우관동맥 50병변(37.9%), 좌회선지 15병변(11.4%), 좌주간동맥이 2병변(1.5%)이었고 단일혈관질환은 69 예(52.3%)였으며 혈관 내 혈전은 59예(44.7%)에서 관 찰되었다. 127명의 환자에서 시술에 성공하였다(96.2%). 경색혈관의 TIMI flow는 시술 전 64명(48.5%)의 환 자에서 0 또는 1로 감소되어 있었으나 시술 후 123명 (93.2%)의 환자에서 3으로 회복되었다. 입원기간 중 사 망은 8예(6.1%), 표적 병변 재관류는 2예(1.6%)있었으 나 출혈과 관련된 합병증은 없었다. 6개월 추적 관동맥 조영술은 62명의 환자(47.2%)에서 평균 6.6개월에 시 행되어 조영술상 재협착은 13예(20.1%)에서 관찰되었 다. 평균 37.2±17.2개월의 추적 기간 중 사망은 12예 (9.1%), 재경색은 1예(0.8%)에서 관찰되었고 관동맥 우회술 5예를 포함한 표적 병변 재관류는 18예(13.6%) 에서 시행 받았다. 추적 관찰기간 동안 주요심장사건(MACE) 이 발생하지 않는 1년 누적 생존율과 3년 누적 생존 율은 각각 80.3%, 76.5%였다. 결 론: 급성심근경색증에서 heparin-coated 스텐트를 이용 한 일차적 관동맥 중재술은 장기 추적관찰에서 양호한 성적을 보였다.

Combined Open and Endovascular Repair for Aortic Arch Pathology

강웅철,신익균,안태훈,이경훈,문찬일,한승환,박철현,박국양,강진모,김정호 대한심장학회 2010 Korean Circulation Journal Vol.40 No.8

Background and Objectives: We describe our experience with combined open and endovascular repair in patients who have aortic arch pathology. Subjects and Methods: This study is a retrospective analysis of 7 patients who underwent combined open and endovascular repair for aortic arch pathology. Medical records and radiographic information were reviewed. Results: A total of 7 consecutive patients (5 men, 71.4%) underwent thoracic stent graft implantation. The mean age was 59.9±16.7 years. The indication for endovascular repair was aneurysmal degeneration in 5 patients, and rupture or impending rupture in 2 patients. In all 7 cases, supra-aortic transposition of the great vessels was performed successfully. Stent graft implantation was achieved in all cases. Surgical exposure of the access vessel was necessary in 2 patients. A total of 9 stent grafts were implanted (3 stent grafts in one patient). The Seal thoracic and the Valiant endovascular stent graft were implanted in 6patients and 1 patient, respectively. There were no post-procedure deaths or neurologic complications. In 2 patients, bleeding and injury of access vessel were noted after the procedure. Postoperative endoleak was noted in 1 patient. One patient died at 10 months after the procedure due to a newly developed ascending aortic dissection. No patients required secondary intervention during the follow-up period. The aortic diameter decreased in 4 patients. In 3 patients, including 1 patient with endoleak,there was no change in aortic diameter. Conclusion: Our experience suggests that combined open and endovascular repair for aortic arch pathology is safe and effective, with few complications.

미만성 긴 관동맥 병변에서 약물 용출성 스텐트의중첩시술은 효과적인가?

강웅철,신익균 대한심장학회 2006 Korean Circulation Journal Vol.36 No.1

Comparison of Outcomes after Device Closure and Medication Alone in Patients with Patent Foramen Ovale and Cryptogenic Stroke in Korean Population

강웅철,문정근,김시훈,오병천,박예민,정욱진,최덕영,이지연,이영배,황희영,안태훈 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.3

Purpose: To compare the effectiveness of device closure and medical therapy in prevention of recurrent embolic event in the Koreanpopulation with cryptogenic stroke and patent foramen ovale (PFO). Materials and Methods: Consecutive 164 patients (men: 126 patients, mean age: 48.1 years, closure group: 72 patients, medical group: 92 patients) were enrolled. The primary end point was a composite of death, stroke, transient ischemic attack (TIA), or peripheralembolism. Results: Baseline characteristics were similar in the two groups, except age, which was higher in the medical group (45.3±9.8 vs. 50.2±6.1, p<0.0001), and risk of paradoxical embolism score, which was higher in the closure group (6.2±1.6 vs. 5.7±1.3, p=0.026). On echocardiography, large right-to-left shunt (81.9% vs. 63.0%, p=0.009) and shunt at rest/septal hypermobility (61.1% vs. 23.9%, p<0.0001) were more common in the closure group. The device was successfully implanted in 71 (98.6%) patients. The primary end point occurred in 2 patients (2 TIA, 2.8%) in the closure group and in 2 (1 death, 1 stroke, 2.2%) in the medical group. Event-free survival rate did not differ between the two groups. Conclusion: Compared to medical therapy, device closure of PFO in patients with cryptogenic stroke did not show difference in reduction of recurrent embolic events in the real world’s setting. However, considering high risk of echocardiographic findings in the closure group, further investigation of the role of PFO closure in the Asian population is needed.

지방행정의 홍보기능, 어떻게 강화할 것인가 ; 지방정부 행정홍보 실태와 활성화 방안

강웅철 대한지방행정공제회 2006 地方行政 Vol.55 No.635

Increasing injection frequency enhances the survival of injected bone marrow derived mesenchymal stem cells in a critical limb ischemia animal model

강웅철,오병천,이경훈,안태훈,변경희 대한약리학회 2016 The Korean Journal of Physiology & Pharmacology Vol.20 No.6

Critical limb ischemia (CLI) is one of the most severe forms of peripheral artery diseases, but current treatment strategies do not guarantee complete recovery of vascular blood flow or reduce the risk of mortality. Recently, human bone marrow derived mesenchymal stem cells (MSCs) have been reported to have a paracrine influence on angiogenesis in several ischemic diseases. However, little evidence is available regarding optimal cell doses and injection frequencies. Thus, the authors undertook this study to investigate the effects of cell dose and injection frequency on cell survival and paracrine effects. MSCs were injected at 106 or 105 per injection (high and low doses) either once (single injection) or once in two consecutive weeks (double injection) into ischemic legs. Mice were sacrificed 4 weeks after first injection. Angiogenic effects were confirmed in vitro and in vivo, and M2 macrophage infiltration into ischemic tissues and rates of limb salvage were documented. MSCs were found to induce angiogenesis through a paracrine effect in vitro, and were found to survive in ischemic muscle for up to 4 weeks dependent on cell dose and injection frequency. In addition, double high dose and low dose of MSC injections increased vessel formation, and decreased fibrosis volumes and apoptotic cell numbers, whereas a single high dose did not. Our results showed MSCs protect against ischemic injury in a paracrine manner, and suggest that increasing injection frequency is more important than MSC dosage for the treatment CLI.

Thrombosuction Utilizing an Export Aspiration Catheter during Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

강웅철,안태훈,한승환,정욱진,신미승,고광곤,최인석,신익균 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.2

Purpose: Effective myocardial reperfusion after primary PCI for an AMI in lesions with a thrombus is limited by distal embolization and the slow/no reflow phenomenon. We evaluated the efficacy of a thrombus reduction technique using an export aspiration catheter for thrombosuction during primary PCI. Materials and Methods: We analyzed 62 patients with AMIs who underwent primary PCI and had a thrombi burden during thrombosuction using an EAC (EAC group; n=31) or without thrombosuction (control group; n=31). Results: Thrombosuction with an EAC was performed safely in all the patients in EAC group without any complications. After the PCI, restoration to a TIMI flow grade 3 was significantly more frequent in the EAC group (26/31 vs. 20/31, p<0.05). However, the TIMI perfusion grade did not differ between the two groups. Further, the corrected TIMI frame counts were lower in the EAC group (23.9±15.1 vs. 34.8±22.5, p<0.05). Although there was no statistical significance, a greater incidence of distal embolization was observed in the control group (16.1%, 5/31) as compared to the EAC group (0/31) (p= 0.056). However, the incidence of major adverse cardiac events at 1 and 6 months did not differ between the two groups. Conclusion: For AMIs, thrombosuction with an EAC before or during PCI is a safe and potentially effective method for restoration of the coronary flow.

급성 심근경색증 환자의 일차적 관동맥 중재술시Export Aspiration Catheter를 이용한 혈전 흡입술의 효과

강웅철,안태훈,한승환,최경림,오규진,정욱진,신미승,고광곤,최인석,신익균 대한심장학회 2005 Korean Circulation Journal Vol.35 No.2

Background and Objectives :Effective myocardial reperfusion following primary percutaneous coronary intervention for safety and efficacy of a thrombus reduction technique, using the export aspiration catheter for thrombosuction prior to primary PCI for AMI. Subjects and Methods :We analyzed 6 1 AMI patients who had a thrombus burden on angiography, after having undergone primary PCI, either with or without EAC (EAC group; n=3 1, 24 males, mean ages 54.7 ±11 .8 years)(control group; n=3 1, 20 males, mean ages 65.5 ± 12.2 years). After the primary PCI, the angiographic findings and clinical outcomes at 1 Results:The procedural and angiographic success rates were 100 (3 1/31) and 93.5 (29/3 1), and 100 (3 1/31) and 87. 1% (27/3 1), respectively. After PCI, the recovery rate to TIMI 3 flow was higher in the EAC than the control group (26/3 1 vs. 20/3 1, p<0.05), and the corected TIMI frame count was less in the EAC than the control group (23.9 ± 15.1 vs. 34.8 ± 22.5, p<0.05). However, there were no different in the TIMI perfusion grade between the two groups. Although there was no statistical significance, distal embolization was more comonly observed in control ( 16.1%, 5/3 1) than the EAC group (0/3 1)(p=0.056). There were no diferences in the incidences of MACE at 1 (0 vs. 7.7%, p=0.237) and 6 months (6.9 vs. 0%, p=0.500) between two groups. In the 3 1 patients who underwent successful thrombosuction, gross thrombi were obtained from 25 (80.6%). Conclusion :In AMI, the use of thrombosuction, with EAC prior to PCI, provides a simple, rapid and potentially effective method for removal of the thrombus burden 배경 및 목적: 급성 심근경색증에서 일차적 관동맥 중재술시 발생하는 원위부 색전증은 효과적인 재관류를 억제할 수 있다. 이를 방지하기 위해 사용되는 기구들 중 하나인 GuardWire Plus system은 독특한 구조와 최초에 직경이 큰 혈관에서 원위부 색전증을 예방하기 위해 개발되었기 때문에 관동맥 중재술에서는 제한적으로만 사용이 가능하다. GuardWire Plus system의 구성 성분중의 하나인 Export Aspiration Catheter (EAC)와 일반 관동맥 중재술용 유도 철선을 이용하여 혈전 흡입술을 시행한다면 GuardWire Plus system의 단점을 극복하고 대부분의 관동맥 혈관에서 비교적 간편하고 신속하게 혈전을 제거 할 수 있다. 본 연구는 급성 심근 경색 환자에서 일차적 관동맥 중재술시 풍선도자 확장이나 스텐트 시술 전 일반 관동맥 중재술용 유도철선과 EAC를 이용한 혈전 흡입술의 효과와 안정성을 알아보고자 하였다. 방 법: 2000년 9월부터 2004년 4월까지 급성 심근경색으로 일차적 관동맥 중재술을 시행 받은 환자들 중 6개월 이상 추적 관찰이 가능했던 62명의 환자를 대상으로 본원에 Guard- Wire Plus system이 도입되어 EAC 사용이 가능하여 이를이용하여 혈전흡입술을 시행한 31명의 환자를, EAC를 이용한 혈전 흡입술을 시도하였으나 혈관 구조상 실패하였거나 이 시스템이 도입되기 이전에 관동맥 중재술을 시행하여 EAC 없이 일차적 관동맥 중재술을 시행 받은 환자 31명의 환자와 비교 하였다. 본 연구의 일차 종결점은 시술 후 관동맥 조영술 상 병변의 TIMI flow, TMPG, corrected TMFC, 윈위부 색전증 발생 유무로 하였고 이차 종결점은 시술 후 1개월, 6개월에 사망이나 심근 경색, 표적 병변 재관류 등 주요 심장 사고가 발생하는 경우로 하였다. 결 과:총 62명의 급성 심근경색 환자(평균 나이: 60.2±13.1세, 남자: 44명)가 일차적 관동맥 중재술을 시행 받았고 이 중 31명의 환자에서 EAC를 이용한 혈전 흡입술을 시행하였다. 관동맥 중재술 후 시술 성공률은 EAC 군이 100%(31/31), 대조군이 93.5%(29/31)였고, 관동맥 조영술상 성공률은 각각 100%(31/31), 87.1%(27/31)였다. EAC 혈전 흡입술을 시행한 31명의 환자 중 25명(80.6%)의 환자에서 혈전을 얻었다. 시술 후 TIMI flow가 3 이상으로 회복된 경우가 EAC 군이 26예(83.9%), 대조군이 20예(64.5%)로 EAC 군에서 유의하게 많았으나(p<0.05) TMPG는 시술 후 측정이 가능했던 환자들 중 EAC 군은 58.3%(12/24), 대조군이 48.0% (12/25)로 양군간에 유의한 차이는 관찰되지 않았다. Corrected TMFC는 EAC 군이 23.9±15.1으로 대조군의 34.8±22.5 보다 유의하게 낮았다(p<0.05). 또한 원위부 색전증은 EAC 군에서 한 예도 발생하지 않았으나 대조군에서는 5예 Woong Chol Kang, et al:Thrombosuction using the EAC before Primary PCI in AMI·179 (16.1%)가 발생하여 통계학적으로 의의는 없었으나 대조군에서 발생빈도가 높은 경향을 보였다(p=0.053). 시술 후 1개월째, 6개월째 주요 심장 사고 발생은 양군간에 유의한 차이는 관찰되지 않았다. 결 론:급성 심근경색증에서 일차적 중재술시 EAC와 일반 관동맥 중재술용 유도 철선을 이용한 혈전흡입술은 효과적이고 안전한 방법이라고 사료되나 장기적인 임상 결과에 대한 이 러한 시술의 효과는 많은 수의 환자를 대상으로 좀 더 많은 전향적이고 무작위적인 연구가 필요할 것으로 보인다.