A Comparison between Mechanical Thrombectomy and Intra-arterial Fibrinolysis in Acute Basilar Artery Occlusion: Single Center Experiences

Seunguk Jung,Cheolkyu Jung,배윤정,최병세,Sang-Wha Lee,Jun Young Chang,Beom Joon Kim,Moon-Ku Han,Hee-Joon Bae,Bae Ju Kwon,Sang-Hoon Cha 대한뇌졸중학회 2016 Journal of stroke Vol.18 No.2

Background and Purpose Recent advances in intra-arterial techniques and thrombectomy devices lead to high rate of recanalization. However, little is known regarding the effect of the evolvement of endovascular revascularization therapy (ERT) in acute basilar artery occlusion (BAO). We compared the outcome of endovascular mechanical thrombectomy (EMT) versus intra-arterial fibrinolysis (IAF)-based ERT in patients with acute BAO. Methods After retrospectively reviewed a registry of consecutive patients with acute ischemic stroke who underwent ERT from September 2003 to February 2015, 57 patients with acute BAO within 12 hours from stroke onset were enrolled. They were categorized as an IAF group (n=24) and EMT group (n=33) according to the primary technical option. We compared the procedural and clinical outcomes between the groups. Results The time from groin puncture to recanalization was significantly shorter in the EMT group than in the IAF group (48.5 [25.3 to 87.8] vs. 92 [44 to 179] minutes; P=0.02) The rate of complete recanalization was significantly higher in the EMT group than in the IAF group (87.9% vs 41.7%; P<0.01). The good outcome of the modified Rankin Scale score≤2 at 3 months was more frequent in the EMT group than in the IAF group, but it was not statistically significant (39.4% vs 16.7%; P=0.06). Conclusions EMT-based ERT in patients with acute BAO is superior to IAF-based ERT in terms of the reduction of time from groin puncture to recanalization and the improvement of the rate of complete recanalization.

Incidence and Clinical Features of Neovascularization of the Iris following Acute Central Retinal Artery Occlusion

Young Ho Jung,안성준,Jeong-Ho Hong,Kyu Hyung Park,Moon-Ku Han,Cheolkyu Jung,우세준 대한안과학회 2016 Korean Journal of Ophthalmology Vol.30 No.5

Purpose: To investigate the incidence of neovascularization of the iris (NVI) and clinical features of patients withNVI following acute central retinal artery occlusion (CRAO). Methods: A retrospective review of 214 consecutive CRAO patients who visited one tertiary hospital betweenJanuary 2009 and January 2015 was conducted. In total, 110 patients were eligible for this study after excludingpatients with arteritic CRAO, a lack of follow-up, iatrogenic CRAO secondary to cosmetic filler injection, orNVI detected before CRAO attack. Fluorescein angiography (FA) was applied until retinal arterial reperfusionwas achieved, typically within 1 to 3 months. Results: The incidence of NVI was 10.9% (12 out of 110 patients). Neovascular glaucoma was found in sevenpatients (6.4%). The mean time to NVI diagnosis after CRAO events was 3.0 months (range, 1 week to 15months). The cumulative incidence was 5.5% at 3 months, 7.3% at 6 months, and 10.9% at 15 months. Severelynarrowed ipsilateral carotid arteries were observed in only three patients (27.3%). The other nine patients(75.0%) showed no predisposing conditions for NVI, such as proliferative diabetic retinopathy or centralretinal vein occlusion. Reperfusion rate and prevalence of diabetes were significantly different between patientswith NVI and patients without NVI (reperfusion: 0% [NVI] vs. 94.7% [no NVI], p < 0.001; diabetes: 50.0%[NVI] vs. 17.3% [no NVI], p = 0.017). Conclusions: CRAO may lead to NVI and neovascular glaucoma caused by chronic retinal ischemia fromreperfusion failure. Our results indicate that follow-up fluorescein angiography is important to evaluate retinalartery reperfusion after acute CRAO events, and that prophylactic treatment such as panretinal photocoagulationshould be considered if retinal arterial perfusion is not recovered.

Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?

Woo Ho Geol,Jung Cheolkyu,Sunwoo Leonard,Bae Yun Jung,최병세,Kim Jae Hyoung,Kim Beom Joon,Han Moon-Ku,Bae Hee-Joon,Jung Seunguk,차상훈 대한신경중재치료의학회 2019 Neurointervention Vol.14 No.2

Purpose: Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. Materials and Methods: From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. Results: Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of <0.1 in univariate analysis (i.e., age and National Institutes of Health Stroke Scale score at admission), pial arterial filling scores higher than a cut-off of 2 were found to be independently associated with favorable clinical outcomes (P=0.012). C-statistic analysis confirmed that our model had the highest prediction power when pial arterial filling scores were dichotomized at >2 vs. ≤2. Conclusion: A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested.

The Korean Academy of Tuberculosis and Respiratory Diseases : Slide Session ; OS-093 : Pulmonary Infection ; Microbiology of Parapneumonic Effusion and Predictive Factors for Mortality in South Korea

( Cheolkyu Park ),( Yong Soo Kwon ),( Hong Joon Shin ),( Boram Lee ),( Hee Jung Ban ),( Injae Oh ),( Kyusik Kim ),( Yuil Kim ),( Sung Chul Lim ),( Young Chul Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Understanding of the bacteriology is critical in treatment of pleural infection. However, there are few studies about pathogens of pleural infection in Korea. This study aimed to determine microbiologic characteristics of pleural infection and identify predictive factors associated with mortality. Methods: We performed a retrospective study analyzing 114 cases of parapneumonic effusion with 134 micro-organisms. We examined pleural uid cultures using two culture systems, BACTEC blood culture and conventional method. Results: Of all isolated organisms, the most frequent pathogen was streptococcal species (35.8%) followed by staphylococci (19.4%), anaerobes (15.7%) and gram negatives (9.0%). In 73 specimens using both culture systems, BACTEC blood culture showed higher culture-positive rate (94.5%) than conventional method (35.6%). Streptococci were main organisms in conventional culture (48.4%), community-acquired infection (58.7%) and all susceptible, whereas staphylococci were major isolates in BACTEC blood culture (28.0%), hospital-acquired infection (33.8%) and drug-resistant organisms (58.8%). Smoking, interventions (pigtail, tube thoracostomy, intrapleural fi brinolytics, surgery), and severity score (CURB-65) were signifi cantly associated with 30-day mortality in univariate analysis. In multivariate analysis, tube thoracostomy (aOR 0.158, 95% CI 0.051 0.489, p=0.001), smoking (aOR 6.958, 95% CI 1.882 25.720, p=0.004) and CURB-65 =2 (aOR 4.204, 95% CI 1.345 13.136, p=0.014) weresignifi cant predictive factors for mortality. Conclusions: Common pathogens of pleural infection in Korea were streptococcal species, staphylococci, and anaerobes. Tube thoracostomy, smoking, and CURB-65 =2 could be predictive factors for death in pleural infection.

Quantitative Magnetic Resonance Angiography in Internal Carotid Artery Occlusion with Primary Collateral Pathway

배윤정,Cheolkyu Jung,김재형,최병세,Eunhee Kim 대한뇌졸중학회 2015 Journal of stroke Vol.17 No.3

Background and Purpose Quantitative magnetic resonance angiography (Q-MRA) enables direct measurement of volume flow rate (VFR) of intracranial arteries. We aimed to evaluate the collateral flows in internal carotid artery (ICA) occlusion with primary collateral pathway via circle of Willis using Q-MRA, and to compare them between patients who recently developed ipsilateral symptomatic ischemia and those who did not. Methods Between 2012 and 2014, 505 patients underwent Q-MRA in our institution. Among these, 33 patients who had unilateral ICA occlusion with primary collateral pathway were identified, and grouped into asymptomatic patients, stable patients with chronic infarction, and symptomatic patients with acute/subacute infarction. Mean VFR (mVFR) in intracranial arteries was measured and compared between the patients’ groups. Kruskal-Wallis test was used for statistical analysis. Results Six patients were asymptomatic, fifteen with chronic infarction were stable, and twelve with acute/subacute infarction were symptomatic. The mVFR of ipsilateral middle cerebral artery in symptomatic patients was significantly lower than those in stable or asymptomatic patients (73.7±45.6 mL/min vs. 119.9±36.1 mL/min vs. 121.8±42.0 mL/min; P=0.04). Total sum of the mVFR of ipsilateral anterior, middle, and posterior cerebral arteries was significantly lower in symptomatic patients than those in other groups (229.3±51.3 mL/min vs. 282.0±68.6 mL/min vs. 314.0±44.4 mL/min; P=0.02). Conclusions Q-MRA could be helpful to demonstrate the difference in the degree of primary collateral flow in ICA occlusion between the patients with recent symptomatic ischemia and those without.

Procedural predictors of delayed cerebral infarction after intra-arterial vasodilator infusion for vasospasm following aneurysmal subarachnoid hemorrhage

Hwang, Gyojun,Jung, Cheolkyu,Sheen, Seung Hun,Kim, Sung Hyun,Park, Sukh Que,Oh, Chang Wan,Kwon, O-Ki Springer-Verlag 2010 Acta neurochirurgica Vol.152 No.9

Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

Kim, Yong-Kyu,Jung, Cheolkyu,Woo, Se Joon,Park, Kyu Hyung The Korean Academy of Medical Sciences 2015 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.30 No.12

<P>Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.</P>

캘리퍼 바디 적용 소재인 A357에 대한 기초물성 테스트에 관한 연구

신상훈(Sanghun Shin),정상균(Sangkyun Jung),정철규(Cheolkyu Jeong),박미자(Mija Park),이창호(Gilryong Hong) 한국자동차공학회 2019 한국자동차공학회 부문종합 학술대회 Vol.2019 No.5

Brakes are a key part of vehicle safety. In addition to core functions such as braking power and reliability, brakes are also required to improve fuel economy, reduce weight for carbon dioxide reduction, improve ride comfort, improve appearance, and improve the structure. To this end, the existing brake caliper body is made of main steel, and a light weight caliper body using aluminum is required in accordance with the global trend of improvement of fuel efficiency and environmental regulation. In this study, basic property test of caliper body using A357 material is performed The results were analyzed.

Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke

Keun-Sik Hong,고상배,유경호,Cheolkyu Jung,박석규,김병문,장철훈,배희준,허지회,오창완,이병철,김범태,김범수,Chin-Sang Chung,윤병우,나정호 대한뇌졸중학회 2016 Journal of stroke Vol.18 No.1

Patients with severe stroke due to acute large cerebral artery occlusion are likely to be severely disabled or dead without timely reperfusion. Previously, intravenous tissue plasminogen activator (IV-TPA) within 4.5 hours after stroke onset was the only proven therapy, but IV-TPA alone does not sufficiently improve the outcome of patients with acute large artery occlusion. With the introduction of the advanced endovascular therapy, which enables more fast and more successful recanalization, recent randomized trials consecutively and consistently demonstrated the benefit of endovascular recanalization therapy (ERT) when added to IV-TPA. Accordingly, to update the recommendations, we assembled members of the writing committee appointed by the Korean Stroke Society, the Korean Society of Interventional Neuroradiology, and the Society of Korean Endovascular Neurosurgeons. Reviewing the evidences that have been accumulated, the writing members revised recommendations, for which formal consensus was achieved by convening a panel composed of 34 experts from the participating academic societies. The current guideline provides the evidence-based recommendations for ERT in patients with acute large cerebral artery occlusion regarding patient selection, treatment modalities, neuroimaging evaluation, and system organization.

Electric-Field-Induced Mass Movement of Ge[sub 2]Sb[sub 2]Te[sub 5] in Bottleneck Geometry Line Structures

Nam, Sung-Wook,Lee, Dongbok,Kwon, Min-Ho,Kang, Dongmin,Kim, Cheolkyu,Lee, Tae-Yon,Heo, Sung,Park, Young-Wook,Lim, Kipil,Lee, Hyo-Sung,Wi, Jung-Sub,Yi, Kyung-Woo,Khang, Yoonho,Kim, Ki-Bum The Electrochemical Society 2009 Electrochemical and solid-state letters Vol.12 No.4