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요골접근법에 의한 관상동맥 스텐트 시술의 가능성과 안정성
차광수(Kwang Soo Cha),김무현(Moo Hyun Kim),김혜진(Hye Jin Kim),양두경(Doo Kyung Yang),조정환(Jeong Whan Cho),박태호(Tae Ho Park),박형렬(Hyung Ryul Park),김봉근(Bong Keun Kim),김영대(Young Dae Kim),김종성(Jong Seong Kim) 대한내과학회 1999 대한내과학회지 Vol.56 No.2
N/A Objectives : Powerful anticoagulant and antiplatelet therapies after coronary stenting may carry the risk of increased bleeding complications if large-bore guiding catheters are introduced via the femoral artery. Recently smaller radial artery is introduced as an entry site for coronary interventions owing to miniaturization of equipments, easy hemostasis and lower access site complications, and little hand ischemia. The purpose of this study is to evaluate the feasibility and safety of coronary stent implantation via the radial artery. Methods : After a learning curve for transradial diagnostic coronary angiography, stent implantation was attempted in 131 consecutive patients, 135 lesions. Immediately after procedure, the introducer sheath was withdrawn and mobilization was initiated. Clinical follow-up was done for punctured radial arteries. Results : Procedural success and uncomplicated clinical course was achieved in 129(98%) patients, 133(99%) lesions. No stent embolization or migration within the coronary artery, and no procedure-related death, Q wave myocardial infarction or emergent bypass surgery were happened. No stroke or severe arm vessel complications were happened except 4(3%) cases of moderate hematoma. Failed 2 cases were in early period and stents did not pass the lesions due to inappropriate selection and poor backup of guiding catheters. During follow-up of 124±36 days, punctured radial arteries showed weak or absent radial pulse in 10(7%) patients, but no claudication or ischemia of hand was observed. Conclusion : Transradial coronary stenting was performed safely with high success rate and low complication rate. This study supports that transradial approach is a promising primary route for coronary stenting.
경요골동맥 관상동맥 조영술을 시행하는 환자에서 요골동맥 사행성의 빈도 및 예측인자
박민아 ( Min Ah Park ),박태호 ( Tae Ho Park ),최재혁 ( Jae Hyuk Choi ),박선이 ( Sun Yi Park ),이수이 ( Su Ee Lee ),임태형 ( Tae Hyung Lim ),유정남 ( Jung Nam Yoo ),차광수 ( Kwang Soo Cha ),김무현 ( Moo Hyun Kim ),김영대 ( Young Da 대한내과학회 2006 대한내과학회지 Vol.71 No.4
목적: 경요골동맥 관상동맥조영술 시행시 요골동맥 사행성은 혈관 박리와 같은 중대한 혈관 합병증을 초래할 수 있지만 요골동맥 사행성을 시술 전에 예측할 수 있는 인자들은 아직 잘 알려져 있지 않다. 따라서 본 연구는 경요골동맥 관상동맥조영술을 시행할 환자들을 대상으로 요골동맥 사행성의 빈도 및 시술 전에 사행성을 예측할 수 있는 인자들을 확인하고자 하였다. 방법: 본 연구는 2004년 12월부터 2005년 6월까지 본원 순환기내과에 경요골동맥 관상동맥조영술 및 중재술을 시행받기 위하여 입원한 158명을 대상으로 하였다. 요골동맥 사행성을 요골동맥조영술로 평가하여 그 빈도를 확인하였다. 요골동맥 사행성을 예견할 수 있는 인자들은 사행성이 관찰되었던 환자군과 관찰되지 않았던 환자군에서 임상 및 시술에 관련된 특징들을 비교하여 분석하였다. 결과: 요골동맥조영술은 154명(97.5%)의 환자에서 시행하였고, 관상동맥조영술은 149명(94.3%)의 환자에서 성공적으로 시행할 수 있었다. 요골동맥 사행성의 빈도는 전체 환자의 22%에서 관찰되었고, 다변량 분석에서 요골동맥의 사행성을 예측할 수 있는 독립적인 인자들은 고령과 미니 유도철선의 진입장애 및 고혈압이었다. 결론: 경요골동맥 관상동맥조영술이 예정된 환자에서 시술 전에 요골동맥 사행성을 예측할 수 있는 인자들로는 고령과 미니 유도철선의 진입장애 및 고혈압 등이었다. 따라서 요골동맥 사행성이 있을 가능성이 높은 환자들은 관상동맥조영술 전에 요골동맥 사행성 유무를 확인하는 것이 안전한 시술을 위하여 필요하리라 생각된다. Background: It is well known that the presence of a tortuous radial artery, in patients undergoing transradial coronary angiography (CAG), may cause undesirable results such as access failure and arterial dissection. Thus, our aim was to investigate the prevalence and predictors of the presence of a tortuous radial artery in patients undergoing transradial CAG. Methods: We prospectively investigated the tortuosity of the radial artery in 158 consecutive patients. The tortuosity of the radial artery was determined by radial angiography. A tortuous radial artery was defined as one with a maximal angulation of more than 45 degrees. To determine the predictors of a tortuous artery, we examined clinical and intra- procedural characteristics. Results: A right radial angiography was easily performed in 154 patients (97.5%) without any complications. A tortuous radial artery was identified in 34 patients (22%). On the univariate analysis, advanced age, female gender, short stature, underweight, hypertension, and absence of progression of the mini-guide wire were significantly associated with the presence of a tortuous radial artery. Significant independent predictors of a tortuous radial artery by multivariate analysis were: advanced age, absence of progression of the mini-guide wire and hypertension. Conclusions: These data showed that the presence of a tortuous radial artery could be predicted by advanced age, absence of progression of the mini-guide wire and a history of hypertension. Thus, identification of a tortuous radial artery prior to coronary angiography may be helpful for a safe transradial CAG in patients at high risk for a tortuous radial artery.(Korean J Med 71:381-387, 2006)
유방현(Bang Hyun Liu),문한규(Han Kyu Moon),허윤(Yoon Huh),양웅석(Ung Suk Yang),이강희(Kang Hi Lee),조중현(Joong Hyeon Cho),백대근(Dae Geun Baek),김무현(Moo Hyung Kim) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1
In cases of Gastointestinal Vascular Malfomnation, which involve the mucosa and submucosa of the gastrointestinal tract, Dieulafoys erosion consists of abnormally large gastric submucosal artery, and ruptures into the stomach. They cause massive or recurrent intragastric bleeding. The lesion is very small and easily overlooked even at laparotomy and can only be correctly diagnosed by endoscopy or arteriography when the patient is actively bleeding. The authers recently observed a case of Dieulafoys disease, this 41-year old man presented an episode of severe melena, but endoscopy and barium enema were all unremarkable. There was history of analgesic abuse because of spondylolisthesis of L4-5. The physical examination was unremarkable except for grossly melenic stools. The hemoglobin was 4.8g/dl. Repeated endoscopy by a more experienced endoscopist demonstrated a vascular malformation at the posterior wall of upper body of stomach with coated blood clot. An angiography including superior mesenteric artery studies, reveal vascular malformation of the left gastroepiploic artery. A total of 30 units of blood had been replaced prior to gastrectomy. Postoperatively, he had no further bleeding. Pathologic examination of the stomach showed dilated prominent blood vessels in the submucosa with focally ectatic capillaries in the lamina propria. Two weeks after operation, the hemoglobin showed 14.0g/dl, and he discharged after improvement.