관동맥성형술 후의 혈관 재협착 및 재형성

채제건 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.2

Percutaneous Transluminal Coronary Angioplasty (PTCA) remains limited by restenosis that occurs in 30 to 50% of patients with coronary artery disease. During the last decade, numerous agents have been used to prevent restenosis. Despite positive results in animal models, no pharmacological therapy has been found to significantly decrease the risk of restenosis in humans. These discrepancies between animal models and clinical situation were probably related to an incomplete understanding of the mechanism of restenosis. Neointimal thickening occurs in response to experimental arterial injury with a balloon catheter. Neointimal formation involves different steps: smooth muscle cell activation, proliferation and migration, and the production of extracellular matrix. The factors that control neointimal hyperplasia include growth factors, humoral factors and mechanical factors. Arterial remodeling also plays a major role in the restenosis process. Studies performed in animal and human subjects have established the potentials for "constrictive remodeling" to reduce the post-angioplasty vessel area, thereby indirectly narrowing the vessel lumen and thus contributing to restenosis. The reduction of restenosis rate in patients with intracoronary stent implantation has been attributed to the preventive effect of stent itself for this negative remodeling. In addition to these mechanisms for restenosis, intraluminal or intra-plaque thrombus formation, reendothelialization and apoptosis theories have been introduced and confirmed at least in part.

두가지 형태의 스테인레스 스틸 풍선확장형 관동맥 튜브스텐트를 경험한 단일 병원에서의 임상결과 비교 연구

채제건,신경덕,김현철,이병현,이수택,김원호,고재기 의과학연구소 2000 全北醫大論文集 Vol.24 No.1

Background and Objectives : Since the introduction of Palmaz-Schatz stent, various second generation stainless steel ballon-expandable tube stents such as MultiLink or NIR stents have been developed and used in the field of coronary intervention. The initial results of these stents were comparable to or even better than those of Palmaz-Schatz stent. However, the clinical and angiographic results comparing with these second generation stents have not been known yet. The purpose of this study was to evaluate the initial and late outcomes of these second-generation tube stents in the experiences of the single institution. Materials and Method : We retrospectively analyzed the efficacy of MultiLink or NIR stents which had been implanted for elective stenting in 140 patients with 155 de novo lesions. Patients with the multiple stents in a single lesion were excluded. There was no limitation of the clinical presentations. Group 1 included the patients who underwent the implantation of short MultiLink 15mm, Group 2 included also the similar length of NIR stent 9mm/16mm. The patients who underwent the implantation of intermediate length of MultiLink 25mm/35mm were group 3, NIR 25(26)mm/32mm was underwent the implantation of intermediate length of MultiLink 25mm/35mm were group3, NIR 25(26)mm/32mm was group 4. Repeat coronary angiography was performed at 187±59 days after stenting with quantitative coronary angiographic analysis (QCA). Results : There were no sgnificant differences in any baseline clinical and angiographic variables between each groups. The mean procedural success rates were 85% and similar in all groups. During the follow-up periods, there were no subacute stent thrombosis, re-infarcrion and death in all groups. Each restenosis rate was 26%, 23%, 14% and 27% and each target lesion revascularization (TLR) rate was 15.0%, 4.7%, 6.7% and 9.5% in group 1, 2, 3 and 4, respectively. These results exhibited that short MultiLink group showed higher TLP rate than short NIR group (p<0.05). Conclusion : There were no sgnificant differences in immediate or midterm clinical and angiographic outcomes after the implantation of MultiLink or NIR stents, which have different designs of stainless-steel ballon expandable tube type except higher TLR rate in short MultiLink than short NIR stents. The midterm outcomes of intermediate length of two tubular stents were similar with those of short stents. However, more experiences and futher evaluations should be warranted.

혈전용해제

채제건 메디메디아코리아(주) 2002 심장과 혈관 Vol.4 No.3

류마티스 관절염 환자에서 심장을 침범한 속발성 유전분증 1예

채제건 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.9

약물용출 스텐트를 이용한 Full Metal Jacket (≥60 mm) 시술의 단기 및 장기 성적

이선화,채제건,이강휴,이상록,이경석,김원호,고재기 대한심장학회 2008 Korean Circulation Journal Vol.38 No.2

Background and Objectives: Drug-eluting stents (DES) are effective for the maintenance of patency in patients with various complex coronary artery diseases. We investigated the efficacy of full metal jackets (FMJs,≥60 mm) using overlapping DES for very long coronary lesions. Subjects and Methods: The medical records and angiographic data of ninety-nine patients, and 100 FMJs that were implanted at Chonbuk National University Hospital since March 2003, were analyzed. Results: The mean age was 63±10 years and median follow-up period was 17.0 months. The mean lesion length was 57.7±10.8 mm, the mean number of implanted DES for FMJ was 2.2±0.5, and the mean length of the FMJ was 68.5±11.4 mm. Thirty percent of the lesions were the culprits of acute myocardial infarction and 22% were chronic total occlusive lesions. The procedural success rate was 98%. Triple antiplatelet agents were prescribed for 37.4% of the patients and the mean duration of clopidogrel use was 11.9±5.7 months. Overall major adverse cardiac events developed in 10% of patients. One patient died of probable stent thrombosis by the Academic Research Consortium definition. Follow-up coronary angiography was performed in 69% of cases. Binary restenosis was documented in 9 lesions (13.0%) and five FMJs (7.2%) were revascularized. Stent fractures were detected in four FMJs (5.8%). Conclusion: Although FMJs using DES may be regarded as a relatively safe and effective therapeutic approach for diffuse long coronary lesions, longer-term follow-up data with a larger population is needed to establish safety including special consideration for strategy of antiplatelet therapy. Background and Objectives: Drug-eluting stents (DES) are effective for the maintenance of patency in patients with various complex coronary artery diseases. We investigated the efficacy of full metal jackets (FMJs,≥60 mm) using overlapping DES for very long coronary lesions. Subjects and Methods: The medical records and angiographic data of ninety-nine patients, and 100 FMJs that were implanted at Chonbuk National University Hospital since March 2003, were analyzed. Results: The mean age was 63±10 years and median follow-up period was 17.0 months. The mean lesion length was 57.7±10.8 mm, the mean number of implanted DES for FMJ was 2.2±0.5, and the mean length of the FMJ was 68.5±11.4 mm. Thirty percent of the lesions were the culprits of acute myocardial infarction and 22% were chronic total occlusive lesions. The procedural success rate was 98%. Triple antiplatelet agents were prescribed for 37.4% of the patients and the mean duration of clopidogrel use was 11.9±5.7 months. Overall major adverse cardiac events developed in 10% of patients. One patient died of probable stent thrombosis by the Academic Research Consortium definition. Follow-up coronary angiography was performed in 69% of cases. Binary restenosis was documented in 9 lesions (13.0%) and five FMJs (7.2%) were revascularized. Stent fractures were detected in four FMJs (5.8%). Conclusion: Although FMJs using DES may be regarded as a relatively safe and effective therapeutic approach for diffuse long coronary lesions, longer-term follow-up data with a larger population is needed to establish safety including special consideration for strategy of antiplatelet therapy.

전혈을 이용한 Biocard^TM Helicobacter pylori IgG One-step Immunochromatographic Test의 유용성

신경덕,채제건,이홍범,이수택,안득수 大韓消化器病學會 1999 大韓消化器病學會誌 Vol.34 No.3

당뇨병 환자에서 관동맥 스탠팅의 임상적 고찰

전현순,채제건,문성기,김원호,고재기 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.3

관동맥내 스텐트 삽입 후 사용한 Ticlopidine과 저분자헤파린 효과에 대한 전향적 무작위 비교연구

신경덕,채제건,문성기,김원호,고재기 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.3

80세 이상 고령 환자에서 약물용출 스텐트를 이용한 관동맥 중재술의 장기 성적

이선화,채제건 대한심장학회 2007 Korean Circulation Journal Vol.37 No.12

Background and Objectives : In this current era of using drug-eluting stents (DES), studies that demonstrate the feasibility and clinical outcome of percutaneous coronary intervention (PCI) using DES in a subset of extremely aged patients are lacking. We investigated the clinical characteristics, therapeutic and clinical outcomes of pa-Subjects and Methods : Fifty-thre octogenarian patients (≥80-years-old) and 1036 non-octogenarian patients (<80-years-old) that had been implanted with DES at Chonbuk National University Hospital since March 203 were enrolled in the study. Medical records of the patients in the two groups were retrospectively reviewed. Results: The mean ages of the patients in the two groups were 83± 2 years and 62± -up period was 15.8± 10.9 months and 21.1± 10.8 months, respectively. The octogenarian group showed an increased prevalence of female patients (58.5% vs. 35.1%, p=0.001), acute coronary syndrome (98.1% vs. 78.6%, p= 0.001), ST-segment elevation myocardial infarction (41.5% vs. 28.3%, p= 0.03 ), shock (17.0% vs. 6.6%, p= 0.004), heart failure (22.6% vs. 9.3%, p= 0.002) and a higher in-hospital major adverse cardiac event (MACE) rate (13.2% vs. 3.5%, p= 0.004) than the non-octogenarian patients. Angiographic restenosis and target lesion revascularization rates were not diferent in both groups, but overall MACE (18.9% vs. 9.9%, p= 0.035) and all-cause mortality (p<0.001) rates were significantly higher in the octogenarian group of patients. Conclusion : Although angiographic folow--octogenarians, the occurrence of short- and long-term MACE was significantly higher in the very elderly group owing to a substantial subset of high-risk patients. (Korean Circ J 2007;37:647-655) 배경 및 목적 80세 이상의 초고령 환자군의 관동맥 질환에 대하여는 중654· Long-Term Outcomes of DES in Octogenarians and Older 재시술보다는 보존적 치료가 선호되어 왔고, 최근 약물용출 스텐트의 사용이 보편화하였지만 이들 집단에서 약물용출 스텐트를 이용한 경피적 관동맥 중재술의 안전성이나 효용성에 대한 국내의 연구 결과는 아직 없었다. 본 연구는 80세 이상 환자군의 허혈성 심질환의 특성 및 약물용출 스텐트 시술 후 단기 및 장기성적을 조사하고자 하였다. 방 법 203년 3월 이후 전북대학교병원 순환기내과에서 관상동맥 질환으로 약물용출 스텐트 시술을 받은 80세 이상의 환자군 53명과 80세 미만의 대조군 1,036명의 의무기록을 후향적으로 분석하였다. 결 과 양군의 평균 연령은 각각 83±2세와 62±11세였고, 80 세 이상 군에서 여자의 비율이 많았다 (58.5% vs. 35.1%, p=0.001). 고령 환자군에서는 거의 대부분이 급성 관동맥 증후군으로 내원하였고 (98.1% vs. 78.6%, p=0.001), ST분 절 상승 급성 심근경색증 (41.5% vs. 28.3%, p=0.003) 및 쇼크 (17.0% vs. 6.6%, p=0.004)와 심부전 (22.6% vs. 9.3%, p=0.002), 그리고 병원내 주요 심장사건의 발생률 (13.2% vs. 3.5%, p=0.004)이 의미 있게 높았다. 양 군 사이에 재 협착률 (12.5% vs. 11.5%, p=0.899)이나 재개통술 빈도 (1.9% vs. 4.1%, p=0.429)는 차이가 없었지만, 80세 이상 환자군에 서 전체 주요 심장사건의 발생 (18.9% vs. 9.9%, p=0.035) 및 총 사망률 (p<0.001)이 유의하게 높았고, 특히 비심인성 사망이 많았다 (11.3% vs. 1.2%, p<0.001). 결 론 80세 이상의 고령 환자군에서 발생하는 관동맥 질환은 안정형 협심증으로 방문하는 빈도가 상대적으로 적고, 무 증상 심근 허혈의 빈도가 높을 것으로 추측되며, 병원에 내 원하는 경우는 쇼크나 심부전을 동반한 급성 관동맥 증후 군의 빈도가 높고, 이와 관련하여 병원내 및 장기 추적시 전체 주요 심장사건의 빈도 및 총 사망률이 대조군에 비해 의미 있게 높았다. 고령 환자의 급성 관동맥 증후군에 대하 여 약물용출 스텐트를 이용한 관동맥 중재술의 시행을 신 중하게 고려할 수 있지만, 향후 보다 많은 환자군을 포함한 대규모의 전향적인 연구가 필요하리라 사료된다.

Cardiovascular Behçet’s Disease Presenting as a Subepicardial Hematoma: An Uneventful 2-Year Clinical Course

이선화,채제건,최종범,이상록,구경숙,김원호,고재기,이경석 한국심초음파학회 2010 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.18 No.3

Cardiovascular involvement in Behçet’s disease is not uncommon and could be life-threatening. We describe here a 28-yearold man, who developed sudden onset chest pain during warfarinization due to deep vein thrombosis. Echocardiography and computed tomography showed a 60×60 mm-sized hematoma in the pericardial space compressing the right heart. Coronary angiography showed totally occluded proximal right coronary artery. The hematoma was located at the subepicardial plane of the right atrium on surgical view and successfully evacuated. Follow-up echocardiography revealed complete resolution of the hematoma. He is doing well for 24 months after surgery.