관상동맥 스텐트의 최근 현황

신은석 대한내과학회 2015 대한내과학회지 Vol.89 No.3

Coronary artery disease is one of the principal causes of mortality worldwide. Andreas Grüntzig initially developed balloon angioplasty to treat the condition. Coronary stenting was first used in the mid-1980s to prevent abrupt vessel closure and restenosis. Stent material and design have received a great deal of attention over the past 30 years. Modern polymer stents feature antiproliferative coatings. Recently, a bioresorbable stent scaffold was introduced. This article focuses on the current status of coronary stents, especially with respect to certain aspects of clinical practice. 펴보면 기존의 스텐트가 갖는 문제점을 찾아내고 개선하여더 나은 임상 결과를 얻고자 했던 노력을 엿볼 수 있다. 흥미로운 점은 오래전 개발된 금속 그물망은 임상 상황에 따라 여전히 시술되고 있는 데 반해, 1세대 약물 방출 스텐트인Cypher와 Taxus는 강력한 신생내막 증식 억제효과로 각광을받았음에도 스텐트 혈전증과 같은 안전성의 문제로 더 이상시술되지 않는다는 점이다. 현재 우리나라에서는 2세대 약물 방출 스텐트가 주로 사용되지만 생융해성 폴리머를 갖는약물방출 스텐트가 좋은 임상 결과를 보여주고 있으며, 국내에 곧 도입될 생체융해성 스캐폴드의 비중도 늘어날 전망이다. 생체융해성 스캐폴드의 경우 아직까지 시술 경험이 없고, 분지부나 만성 폐색 및 좌주간지 등의 복합 병변에 대한임상 결과가 부족하다. 하지만 스텐트 시술 이후의 장기적인안전성을 고려하고 생체융해성 스캐폴드 시술 후 혈관 고유의 기능을 유지하여 예후를 개선하는 결과와 이어진다면 관상동맥 스텐트의 변천사에 큰 갈림길이 될 것이다

Serial Morphological Changes of Side-Branch Ostium after Paclitaxel-Coated Balloon Treatment of De Novo Coronary Lesions of Main Vessels

신은석,허애영,안소희,Gillian Balbir Singh,김용훈,Takayuki Okamura,Scot Garg,구본권 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.3

Purpose: The effects on the side-branch (SB) ostium, following paclitaxel-coated balloon (PCB) treatment of de novo coronary lesionsof main vessels have not been previously investigated. This study was aimed at evaluating the serial morphological changes of the SB ostium after PCB treatment of de novo coronary lesions of main vessels using optical coherence tomography (OCT). Materials and Methods: This prospective, single-center observational study enrolled patients with de novo lesions, which were traversed by at least one SB (≥1.5 mm) and were treated with PCB. The SB ostium was evaluated with serial angiographic and OCT assessments pre- and post-procedure, and at 9-months follow-up. Results: Sixteen main vessel lesions were successfully treated with PCB, and 26 SBs were included for analysis. Mean SB ostial lumenarea increased at 9-months follow-up (0.92±0.68 mm2 pre-procedure, 1.03±0.77 mm2 post-procedure and 1.42±1.18 mm2 at 9-months). The SB ostial lumen area gain was 0.02±0.24 mm2 between pre- and post-procedure, 0.37±0.64 mm2 between post-procedure and 9-months, and 0.60±0.93 mm2 between pre-procedure and 9-months. The ostial lumen area increased by 3.9% [interquartile range (IQR) of -33.3 to 10.4%] between pre- and post-procedure, 52.1% (IQR of -0.7 to 77.3%) between post-procedureand 9-months and 76.1% (IQR of 18.2 to 86.6%) between pre-procedure and 9-months. Conclusion: PCB treatment of de novo coronary lesions of main vessels resulted in an increase in the SB ostial lumen area at 9-months.

개원의 연수강좌 : 허혈성 심질환 환자의 외래관리 및 처방

신은석 대한내과학회 2013 대한내과학회 춘계학술대회 Vol.2013 No.-

Essentials of Primary Care : 순환기 (컨벤션홀 C) ; 비판막성 심방세동 환자에서 뇌졸중 예방을 위한 최신 치료 기법

신은석 대한내과학회 2015 대한내과학회 춘계학술대회 Vol.2015 No.-

새로운 항균활성을 보이는 토양 분리 세균 Paenibacillus polymyxa DY1의 분류와 동정

신은석,이희무,이복권,김성훈,권순일,유관희,Shin, Eun-Seok,Lee, Hee-Moo,Lee, Bok-Kwon,Kim, Sung-Hoon,Kwon, Sun-Il,Yoo, Kwan-Hee 한국미생물학회 2007 미생물학회지 Vol.43 No.1

항생제 내성 세균의 출현으로 새로운 항생물질의 개발에 대한 필요성이 대두되고 있다. 본 연구에서는 새로운 항균활성물질을 개발하고자 강원도 대암산 용늪 토양으로부터 새로운 항균물질을 생산하는 균을 분리하였고, 이를 동정하였다. 생화학적인 시험과 16S ribosomal DNA 염기서열 분석결과 Paenibacillus polymyxa균과 가장 높은 상동성을 보여주었다. 지방산 조성의 분석에서도 이 균주는 Paenibacillus polymyxa와 가장 가까웠다. 이 균주가 생산하는 항균물질은 1군 법정 전염병을 일으키는 Samonella enterica serovar Typhi와 Shigella dysentery, enterohaemorrhagic Eschelichia coli, 그리고 Vibrio cholera등의 병원성 세균에 성장억제 효과를 나타냈으며, 다른 일반 식중독 장내세균에서도 성장억제 효과를 나타냈다. 이 균주가 생산하는 항균활성 물질은 과거에 보고된 것과 다른 새로운 것으로 보이며, 광범위한 항균활성으로 인하여 새로운 항생물질 개발 후보로 많은 잠재력을 가진 것으로 평가된다. The DY1 strain of Gram-positive, rod-shaped bacteria was isolated from the soil sample collected from Daeam mountain, Korea. The culture filtrate of DY1 strain showed a broad spectrum of antimicrobial activity on various pathogenic and food poisoning enteric bacterial species tested in vitro. It showed significant growth-inhibitory effect on Salmonella enterica sp., Shigella sp., pathogenic Escherichia coli, Vibrio cholerae, Vibrio parahemolyticus, and Yersinia enterocolitica. For the identification of the DY1 strain, morphological, biochemical and molecular phylogenetic approaches were performed. The DY1 strain was found to be a member of the genus Paenibacillus on the basis of morphological and biochemical analyses. The 16S rDNA of DY1 showed the highest pairwise identity with Paenibacillus polymyxa with 99.79% (1,413 bp/1,416 bp). The antimicrobial entity from DY1 looked different from preciously reported ones and seems to have a great potential to be further studied as a candidate of new antibiotics to control multi-drug resistant pathogens.

제 50 차 대한내과학회 추계학술대회 초록집 : Ross 식 수술의 조기 성적

신은석,임달수,박헌식,류재춘,홍석근,황홍곤 대한내과학회 1998 대한내과학회 추계학술대회 Vol.55 No.-

Prediction of Coronary Atherosclerotic Ostial Lesion with a Damping of the Pressure Tracing during Diagnostic Coronary Angiography

신은석,허애영,안소희,Gillian Balbir Singh,김용훈,구본권 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.1

Purpose: When performing coronary angiography (CAG), diagnostic catheter intubation to the ostium can cause damping of thepressure tracing. The aim of this study was to determine the predictors of atherosclerotic ostial stenosis in patients showing pressuredamping during CAG. Materials and Methods: In total, 2926 patients who underwent diagnostic CAG were screened in this study. Pressure dampingwas defined as an abrupt decline of the coronary blood pressure with a blunted pulse pressure after engagement of the diagnosticcatheter. According to CAG and intravascular ultrasound (IVUS), we divided damped ostia into two groups: atherosclerotic ostiallesion group (true lesion group) and non-atherosclerotic ostium group (false lesion group). Clinical and angiographic characteristicswere compared between the two groups. Results: The overall incidence of pressure damping was 2.3% (68 patients and 76 ostia). Among the pressure damped ostia, 40.8%(31 of 76 ostia) were true atherosclerotic ostial lesions (true lesion group). The true lesion group had more frequent left main ostialdamping and more percutaneous coronary interventions (PCIs) performed on non-ostial lesions, compared to the false lesiongroup. On multivariate logistic regression analysis, left main ostial damping [hazard ratio (HR) 4.11, 95% confidence interval (CI)1.24–13.67, p=0.021] and PCI on non-ostial lesion (HR 5.34, 95% CI 1.34–21.27, p=0.018) emerged as independent predictors fortrue atherosclerotic ostial lesions in patients with pressure damping. Conclusion: Left main ostial damping and the presence of a non-ostial atherosclerotic lesion may suggest a significant true atheroscleroticlesion in the coronary ostium.

수중 항만 콘크리트 구조물의 재료 물성치 평가를 위한 초음파 기반 NDE 기술

신은석,이창길,박승희,한상훈 한국구조물진단유지관리학회 2012 한국구조물진단학회 학술발표회논문집 Vol.2012 No.1

In this study, three kinds of nondestructive evaluation (NDE) techniques for the effective maintenance of underwater concrete structures are investigated: schmidt hammer-based NDE, indirect ultrasonic waves-base NDE and impact echo method using noncontact air-coupled sensing system. Currently, lots of limitations to implement these techniques to real-world structures are being considered.

반발경도와 초음파속도를 이용한 수중 콘크리트 구조물의 압축강도 예측 기술

신은석,이지성,박승희,한상훈 한국구조물진단유지관리공학회 2014 한국구조물진단유지관리공학회 논문집 Vol.18 No.4

본 논문은 기존 수중 콘크리트 구조물의 강도관리 및 진단기술의 중요성은 날로 증가함에 따라 개발되고 있는 ROV (Remote Control Vehicle)에 탑재될 수 있는 비파괴 검사 장비를 개발하여 콘크리트 내부의 강도측정을 하고자하였다. 수중화된 슈미트해머와 초음파센서를 통하여 수중에 있는 콘크리트 공시체의 반발경도 및 초음파속도를 계측하여 실제 압축강도 값과 비교하였으며 이를 통하여 수중에서의 강도추정식을 도출하였다. 도출된 3가지 식 중에서 반발경도와 초음파속도를 복합적으로 사용하는 복합식이 가장 정확도가 높았으며 이에 따라 실제 수중에서의 콘크리트의 강도를 추정하고자 할 때 활용 가능성도 높아질 것으로 예상된다. As the earth's current global warming has caused elevation of sea water temperature, size of storms is foreseen to increase and consequently large damages on port facilities are to be expected. In addition, due to the improved processing efficiency of port cargo volume and increasing necessity for construction of eco-friendly port, demands for various forms of port facilities are anticipated. In this study, two kinds of nondestructive evaluation (NDE) techniques (rebound hardness and ultrasonic pulse velocity methods) are investigated for the effective maintenance of smart green harbor system. A new methodology to estimate the underwater concrete strengths is proposed and its feasibility is verified throughout a series of experimental works.

Long-term Clinical Outcomes of Drug-Coated Balloon Treatment for De Novo Coronary Lesions

신은석,허애영,김빛나,안서희,박용휘,조정래,정영훈 연세대학교의과대학 2023 Yonsei medical journal Vol.64 No.6

Purpose: Data are limited on the long-term efficacy and safety of drug-coated balloon (DCB) treatment in comparison to drug eluting stent (DES) for de novo coronary lesions. We investigated the long-term clinical outcomes of DCB treatment in percuta neous coronary intervention (PCI) for de novo coronary lesions. Materials and Methods: A total of 103 patients scheduled for elective PCI for de novo non-small coronary lesions (≥2.5 mm) who were successfully treated with DCB alone were retrospectively compared with 103 propensity-matched patients treated with sec ond-generation DES from the PTRG-DES registry (n=13160). All patients were followed for 5 years. The primary endpoint was major adverse cardiac events [MACE; cardiac death, myocardial infarction, stroke, target lesion thrombosis, target vessel revascu larization (TVR), and major bleeding] at 5 years. Results: At 5-year clinical follow-up, Kaplan-Meier estimates of the rate of MACE were significantly lower in the DCB group [2.9% vs. 10.7%; hazard ratio (HR): 0.26; 95% confidence interval (CI): 0.07–0.96; log-rank p=0.027]. There was a significantly lower inci dence of TVR in the DCB group (1.0% vs. 7.8%; HR: 0.12; 95% CI: 0.01–0.98; long-rank p=0.015), and there was major bleeding only in the DES group (0.0% vs. 1.9%; log-rank p=0.156). Conclusion: At 5-year follow-up, DCB treatment was significantly associated with reduced incidences of MACE and TVR, com pared with DES implantation, for de novo coronary lesions.