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Prevalence of Unruptured Intracranial Aneurysm on MR Angiography
전태연,전평,김건하 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.5
Objective: To evaluate the prevalence of incidentally found unruptured intracranial aneurysms (UIAs) on the brain MR angiography (MRA) from a community-based general hospital. Materials and Methods: This was a prospectively collected retrospective study, carried out from January 2004 to December 2004. The subjects included 3049 persons from a community-based hospital in whom MRA was performed according to a standardized protocol in an outpatient setting. Age- and sex-specific prevalence of UIAs was calculated. The results by MRA were compared with intra-arterial digital subtraction angiography (DSA) findings. Results: Unruptured intracranial aneurysms were found in 137 (5%) of the 3049 patients (M:F = 43:94; mean age, 60.2years). The prevalence of UIAs was 5% (n = 94) in women and 4% (n = 43) in men, respectively (p = 0.2046) and showed no age-related increase. The most common site of aneurysm was at the distal internal carotid artery (n = 64, 39%),followed by the middle cerebral artery (n = 40, 24%). In total, 99% of aneurysms measured less than 12 mm, and 93% of aneurysms measured less than 7 mm. Direct comparisons between MRA and DSA were available in 70 patients with 83 UIAs;the results revealed two false positive and two false negative results. Conclusion: This community-hospital based study suggested a higher prevalence of UIAs observed by MRA than previously reported. These findings should be anticipated in the design and use of neuroimaging in clinical practice.
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Endovascular Coil Embolization of Very Small Intracranial Aneurysms
채길성,전평,김건하,김성태,김형진,변홍식 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.5
Objective: We aimed to evaluate the results of endovascular coil embolization for very small aneurysms (≤ 3 mm). Materials and Methods: Between March 2005 and December 2008, a total of 31 very small aneurysms in 30 patients were treated by coil embolization. Of the 31 aneurysms, five (16%) were ruptured, as opposed to 26 (84%) that were not. We assessed the procedural complications, immediate angiographic outcome after coiling, clinical outcome, and follow-up MR angiography (MRA). Results: Two thromboembolic complications occurred during the procedure, but did not lead to any persistent neurologic deficit. No procedural aneurysmal rupture was observed and procedure-related morbidity and mortality were both 0%. Occlusion was adequate in 25 aneurysms (81%) and incomplete in six aneurysms (19%). The clinical outcomes of five patients with ruptured aneurysms were good (Glasgow outcome scale ≥ 4), with no bleeding of the treated aneurysms during a mean follow-up period of 13.3 months. On 27 follow-up MRA, there was no recurrence, and the five incompletely occluded aneurysms showed a spontaneous amelioration resulting in an adequate occlusion. Conclusion: Coil embolization of very small aneurysms is technically feasible with good results. The long-term efficacy and the potential as a standard treatment strategy remain to be determined by randomized large trials. Objective: We aimed to evaluate the results of endovascular coil embolization for very small aneurysms (≤ 3 mm). Materials and Methods: Between March 2005 and December 2008, a total of 31 very small aneurysms in 30 patients were treated by coil embolization. Of the 31 aneurysms, five (16%) were ruptured, as opposed to 26 (84%) that were not. We assessed the procedural complications, immediate angiographic outcome after coiling, clinical outcome, and follow-up MR angiography (MRA). Results: Two thromboembolic complications occurred during the procedure, but did not lead to any persistent neurologic deficit. No procedural aneurysmal rupture was observed and procedure-related morbidity and mortality were both 0%. Occlusion was adequate in 25 aneurysms (81%) and incomplete in six aneurysms (19%). The clinical outcomes of five patients with ruptured aneurysms were good (Glasgow outcome scale ≥ 4), with no bleeding of the treated aneurysms during a mean follow-up period of 13.3 months. On 27 follow-up MRA, there was no recurrence, and the five incompletely occluded aneurysms showed a spontaneous amelioration resulting in an adequate occlusion. Conclusion: Coil embolization of very small aneurysms is technically feasible with good results. The long-term efficacy and the potential as a standard treatment strategy remain to be determined by randomized large trials.
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Ethanol Sclerotherapy for the Management of Craniofacial Venous Malformations: the Interim Results
이인호,김건하,전평,변홍식,김형진,김성태,김동익,최준영,김영욱 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.3
Objective: We wanted to evaluate the safety and feasibility of ethanol sclerotherapy for treating craniofacial venous malformations (CVMs). Materials and Methods: From May 1998 to April 2007, 87 patients (40 men and 47 women; age range, 2-68 years) with CVMs underwent staged ethanol sclerotherapy (range, 1-21 sessions; median number of sessions, 2) by the direct puncture technique. Clinical follow up (range, 0-120 months; mean follow up, 35 months; median follow up, 28 months) was performed for all the patients. Therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms in all patients, as well as the degree of devascularization, which was determined on the follow-up imaging, in 71 patients. Results: A total of 305 procedures with the use of ethanol were performed in 87 patients. Follow-up imaging studies were performed for 71 of 87 patients. Twenty-three (32%) of the 71 patients showed excellent outcomes, 37 patients (52%) showed good outcomes and 11 patients (16%) showed poor outcomes. Ethanol sclerotherapy was considered effective for 60 patients. All the minor complications such as bulla (n = 5) healed with only wound dressing and observation. Any major complication such as skin necrosis did not develop. Conclusion: Percutaneous ethanol sclerotherapy is an effective, safe treatment for CVMs. Objective: We wanted to evaluate the safety and feasibility of ethanol sclerotherapy for treating craniofacial venous malformations (CVMs). Materials and Methods: From May 1998 to April 2007, 87 patients (40 men and 47 women; age range, 2-68 years) with CVMs underwent staged ethanol sclerotherapy (range, 1-21 sessions; median number of sessions, 2) by the direct puncture technique. Clinical follow up (range, 0-120 months; mean follow up, 35 months; median follow up, 28 months) was performed for all the patients. Therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms in all patients, as well as the degree of devascularization, which was determined on the follow-up imaging, in 71 patients. Results: A total of 305 procedures with the use of ethanol were performed in 87 patients. Follow-up imaging studies were performed for 71 of 87 patients. Twenty-three (32%) of the 71 patients showed excellent outcomes, 37 patients (52%) showed good outcomes and 11 patients (16%) showed poor outcomes. Ethanol sclerotherapy was considered effective for 60 patients. All the minor complications such as bulla (n = 5) healed with only wound dressing and observation. Any major complication such as skin necrosis did not develop. Conclusion: Percutaneous ethanol sclerotherapy is an effective, safe treatment for CVMs.
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무증상경동맥협착의 치료: 2012년 한국뇌졸중일차예방 진료지침 부분개정
김한영,김성림,전평,강현승,강규식,구자성,박종무,조용진,한상원,유경호,나정호,허지회,권순억,오창완,배희준,이병철,윤병우,홍근식 대한신경과학회 2012 대한신경과학회지 Vol.30 No.2
Extracranial carotid stenosis is a well-established, modifiable risk factor for stroke. Asymptomatic extracranial carotid stenosis is increasingly being detected due to the introduction of less-invasive and more-sensitive advanced diagnostic technologies. For severe asymptomatic stenosis, earlier pivotal clinical trials demonstrated the benefit of carotid endarterectomy over the best medical therapy. Since then, great advances have been made in interventional and medical therapies as well as surgical techniques. The first edition of the Korean Stroke Clinical Practice Guidelines for primary stroke prevention for the management of asymptomatic carotid stenosis reflected evidences published before June 2007. After the publication of the first edition, several major clinical trials and observational studies have been published, and major guidelines updated their recommendation. Accordingly, the writing group of Korean Stroke Clinical Practice Guidelines (CPG) decided to provide timely updated evidence-based recommendations. The Korean Stroke CPG writing committee has searched and reviewed literatures related to the management of asymptomatic carotid stenosis including published guidelines, meta-analyses, randomized clinical trials, and nonrandomized studies published between June 2007 and Feb 2011. We summarized the new evidences and revised our recommendations. Key changes in the updated guidelines are the benefit of intensive medical therapy and further evidence of carotid artery stenting as an alternative to carotid endarterectomy. The current updated guidelines underwent extensive peer review by experts from the Korean Stroke Society, Korean Society of Intravascular Neurosurgery, Korean Society of Interventional Neuroradiology, Korean Society of Cerebrovascular Surgery, and Korean Neurological Association. New evidences will be continuously reflected in future updated guidelines. Extracranial carotid stenosis is a well-established, modifiable risk factor for stroke. Asymptomatic extracranial carotid stenosis is increasingly being detected due to the introduction of less-invasive and more-sensitive advanced diagnostic technologies. For severe asymptomatic stenosis, earlier pivotal clinical trials demonstrated the benefit of carotid endarterectomy over the best medical therapy. Since then, great advances have been made in interventional and medical therapies as well as surgical techniques. The first edition of the Korean Stroke Clinical Practice Guidelines for primary stroke prevention for the management of asymptomatic carotid stenosis reflected evidences published before June 2007. After the publication of the first edition, several major clinical trials and observational studies have been published, and major guidelines updated their recommendation. Accordingly, the writing group of Korean Stroke Clinical Practice Guidelines (CPG) decided to provide timely updated evidence-based recommendations. The Korean Stroke CPG writing committee has searched and reviewed literatures related to the management of asymptomatic carotid stenosis including published guidelines, meta-analyses, randomized clinical trials, and nonrandomized studies published between June 2007 and Feb 2011. We summarized the new evidences and revised our recommendations. Key changes in the updated guidelines are the benefit of intensive medical therapy and further evidence of carotid artery stenting as an alternative to carotid endarterectomy. The current updated guidelines underwent extensive peer review by experts from the Korean Stroke Society, Korean Society of Intravascular Neurosurgery, Korean Society of Interventional Neuroradiology, Korean Society of Cerebrovascular Surgery, and Korean Neurological Association. New evidences will be continuously reflected in future updated guidelines.
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