하지 심부정맥혈전증 환자에서 폐색전증 발생에 미치는 인자

윤상섭,최승혜,김상동,조항주,박순철,김기환,안창혁,김정수,문인성,유승진,임근우,김지일 대한뇌혈관외과학회 2008 대한뇌혈관외과학회지 Vol.24 No.2

Purpose: Pulmonary embolism (PE) represents the most important and fatal complication of deep vein thrombosis (DVT), of which a dislodged thrombus is most commonly derived from the deep venous system of the lower extremity. The aim of this study is to define the incidence and risk factors of PE in DVT patients. Method: We retrospectively reviewed 248 patients with DVT in a lower extremity at Uijeongbu St. Mary's Hospital between January 2000 and August 2008 and they had received additional examinations for making the diagnosis of PE regardless of its symptoms. Result: There were 117 men and 131 women, and their mean age was 59 years old (range: 13∼91) at the time of diagnosis. There were 190 DVT-only patients and 58 patients with PE (the incidence rate of PE in the DVT patients: 23.8%). The gender ratio of the DVT only group was 1:1.3 (males: 83, female: 107) and the gender ratio of the DVT with PE group was 1:0.7 (males: 34, females: 24) (P<0.05). The risk factors of PE in the DVT patients were hypercoagulability (34%), cancer (23%), immobilization (17%), trauma/operation (10%), obesity (10%) and a past DVT history (7%). The idiopathic DVT patients had a relatively high cancer diagnosis rate (18.5%) and the majority of the newly detected cancer were from the chest or abdominal cavity. Conclusion: The incidence of DVT and PE is increasing and 23.8% of the DVT patients showed PE on their chest CT scan. The most significant risk factor for PE in the DVT patients was the male gender, yet an evaluation for cancer should be carefully done for idiopathic DVT patients because of their high rate of having cancer diagnosed.

Clinical and Angiographic Outcomes of Wingspan Stent Placement for Treatment of Symptomatic Intracranial Stenosis: Single Center Experience with 19 Cases

Jun Hyoung Lee,Ji Kwang Yun,김대원,강성돈 대한뇌혈관외과학회 2012 Journal of Cerebrovascular and Endovascular Neuros Vol.14 No.3

Objective:The limitations of medical management of symptomatic intracranial arterial stenosis (ICS) have prompted development of new strategies, including endovascular treatment. However, stenting of symptomatic ICS remains investigational. Here, we have reported and analyzed a series of 19 endovascular procedures involving placement of a Wingspan stent. Methods:We conducted a retrospective review of a series of ICS in which patients were treated with percutaneous transarterial balloon angioplasty and stent placement (PTAS). Patients included in the study were diagnosed as symptomatic ICS between May 2010 and September 2011. Results:Nineteen patients (median age, 65 years; 12 males, seven women) were treated with the Wingspan stent system for symptomatic ICS ranging from 50% to 99%. The technical success rate was 100%. The location of ICS included the internal carotid (n = 5; 1 petrous, 3 cavernous, and 1 clinoid segments), vertebral (n = 1; V4 segment), basilar (n = 1), and middle cerebral (n = 12; 9 M1, 3 M2) arteries. There was no occurrence of procedure-related mortality. Periprocedural morbidity occurred in two cases (10.5%), including carotid-cavernous fistula (n = 1) and subarachnoid hemorrhage (n = 1). No ipsilateral stroke was recorded beyond 30 days during a mean follow-up period of 13.2 months (range 9–19 months). Restenosis (> 50%) was observed in one patient (6.3%), who was asymptomatic, on follow-up imaging. Conclusion:Wingspan stent for symptomatic ICS can be performed with a high rate of technical success and acceptable periprocedural morbidity rates. Our initial experience indicates that this procedure represents a viable treatment option for this patient population.

Pathophysiology and classification of intracranial and spinal dural AVF

Sook Young Sim 대한뇌혈관외과학회 2022 Journal of Cerebrovascular and Endovascular Neuros Vol.24 No.3

Dural arteriovenous fistulas (DAVFs) are pathologic shunts between pachymeningeal arteries and dural venous channel. DAVFs are relatively rare, however, DAVFs can lead to significant morbidity and mortality due to intracranial hemorrhage and non-hemorrhagic neurologic deterioration related to leptomeningeal venous drainage. The etiology and pathophysiology of DAVFs is not fully understood. Several hypotheses for development of DAVF and classifications for predicting risk of hemorrhage and neurological deficit have been proposed to help clinical decision making according to its natural history. Herein, incidence, etiology, pathophysiology of development of intracranial and spinal DAVF including their classifications are briefly described with short historical review.

Deconstructive repair of a traumatic vertebrovertebral arteriovenous fistula via a contralateral endovascular approach

Nageshwaran Sathiji K.,Deng Francis,Regenhardt Robert W.,Das Alvin S.,Alotaibi Naif M.,Patel Aman B.,Stapleton Christopher J. 대한뇌혈관외과학회 2022 Journal of Cerebrovascular and Endovascular Neuros Vol.24 No.3

Vertebrovertebral arteriovenous fistulas (VVAVFs) are rare entities that lack consensus guidelines for their management. Our case describes the successful treatment of a traumatic VVAVF via a contralateral deconstructive endovascular approach. A 64-year-old female presented following a traumatic fall. Computed tomography angiogram highlighted a 2 cm pseudoaneurysm of the right vertebral artery (VA) with epidural contrast enhancement and a hematoma with flow voids within the epidural space. Digital subtraction angiography showed a VVAVF at C2-3 with retrograde filling of the distal right VA. Having undergone several unsuccessful passes of the proximal dissection flap in the right VA, the patient underwent a contralateral deconstructive approach with correction of the VVAVF without complication. The remaining feeding branches had occluded after 1 week. The patient made a complete recovery without neurological sequelae at 3-month follow-up.

고연령군 뇌동맥류 파열 환자의 치료 결과

윤기성,최찬영,한성록,이기택,손문준,이채혁 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.3

Objective : This study aimed to assess the results of surgical and endovascular treatments in aneurysmal subarachnoid hemorrhage (SAH) patients older than 70 years. Methods : This study included 18 patients, more than 70 years of age, treated for ruptured cerebral aneurysms between April 2004 and March 2009. In most cases, patients underwent the early obliteration procedure for each aneurysm, and we compared the clinical results according to the obliteration method (clipping or coiling). We assessed neurological outcomes at 6 months post-procedure according to the modified Rankin Scale (mRS): favorable (mRS score > 2) or unfavorable (mRS score > 2). Results : Of the 18 patients, 12 (66.6%) underwent obliteration of the aneurysm sac via microvascular clipping patients, and 6 (33.3%) underwent endovascular coiling. At 6 months post-procedure, the clinical outcomes were favorable in 6 patients (33.3%), 5 (41.7%) who received microvascular clipping and 1 (16.7%) who underwent endovascular coiling. Unfavorable outcome was not statistically associated with poor initial clinical state, poor Fisher grade, occurrence of stroke, or hydrocephalus, although we frequently noted these variables in the unfavorable outcomes. Conclusions : In this study, aneurysm obliteration method (microvascular clipping vs. endovascular coiling) did not seem to significantly affect clinical outcomes. A poor initial clinical state, poor Fisher grade, occurrence of stroke, and hydrocephalus seemed to be associated with poor clinical outcomes. (Kor J Cerebrovascular Surgery 12(3):190-195, 2010)

Intra-arterial Onyx Embolization of Vertebral Body Lesions

Neda I. Sedora-Roman,Bradley A. Gross,Arra Suresh Reddy,Christopher S. Ogilvy,Ajith J. Thomas 대한뇌혈관외과학회 2013 Journal of Cerebrovascular and Endovascular Neuros Vol.15 No.4

While Onyx embolization of cerebrospinal arteriovenous shunts is well-established,clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically,a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.

Volume Measurement of the Intracranial Aneurysm: A Discussion and Comparison of the Alternatives to Manual Segmentation

Siang-Hua Victor Chan,Kai-Sing Alain Wong,Yat-Ming Peter Woo,Kwong-Yau Chan,Kar-Ming Leung 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.4

Objective : Several modalities are available for volumetric measurement ofthe intracranial aneurysm. We discuss the challenges involved in manualsegmentation, and analyze the application of alternative methods usingautomatic segmentation and geometric formulae in measurement of aneurysmvolumes and coil packing density. Methods : The volumes and morphology of 38 aneurysms treated withendovascular coiling at a single center were measured using three-dimensionalrotational angiography (3DRA) reconstruction software using automaticsegmentation. Aneurysm volumes were also calculated from theirheight, width, depth, size of neck, and assumed shape in 3DRA imagesusing simple geometric formulae. The aneurysm volumes were dichotomizedas "small" or "large" using the median volume of the studied population(54 mm3) measured by automatic segmentation as the cut-off valuefor further statistical analysis. Results : A greater proportion of aneurysms were categorized as being"small" when geometric formulae were applied. The median aneurysm volumesobtained were 54.5 mm3 by 3DRA software, and 30.6 mm3 usingmathematical equations. An underestimation of aneurysm volume with aresultant overestimation in the calculated coil packing density (p = 0.002)was observed. Conclusion : Caution must be exercised in the application of simple geometricformulae in the management of intracranial aneurysms as volumesmay potentially be underestimated and packing densities falsely elevated. Future research should focus on validation of automatic segmentation involumetric measurement and improving its accuracy to enhance its applicationin clinical practice.

The experience of surgery and endovascular procedure of cerebrovascular disease in the hybrid operating room; Multi-axis robotic C-arm DSA system

Chang Hyeun Kim,이상원,Young Ha Kim,성순기,손동욱,송근성 대한뇌혈관외과학회 2020 Journal of Cerebrovascular and Endovascular Neuros Vol.22 No.4

Objective: To report on combined surgical and/or endovascular procedures for cerebrovascular disease in a hybrid operating room (OR). Methods: Between October 2016 and June 2020, 1832 neurosurgical procedures were performed in a hybrid OR. Our institution’s hybrid OR consists of a multi-axis robotic C-arm monoplane digital subtraction angiography (DSA) system with an operating table, 3D-rotational DSA, cone-beam computed tomography (dyna CT), and real-time navigation software. Procedures were categorized into six categories according to purpose: (1) simple diagnosis and follow-up, (2) simple endovascular procedure, (3) combination of surgery and endovascular procedures, (4) rescue surgery after endovascular procedures, (5) frameless stereotactic procedure, and (6) other surgeries requiring C-arm. Results: Of 1832 neurosurgical procedures in the hybrid OR, 1430 were simple diagnosis and follow-up cases, 330 simple endovascular procedures, 8 combination of surgery and endovascular procedures, 15 rescue after endovascular procedure, 40 frameless stereotactic procedures, and 9 other surgeries. Eight cases of combination of surgery and endovascular procedures, safely performed without wasting time on patient transfer, were performed in seven bypass end endovascular procedures and one case of bow-hunter syndrome in complex cerebrovascular disease. After embolization, craniotomy (or craniectomy) and intracerebral hemorrhage removal were performed in eight patients in-situ. Of the 40 frameless stereotactic procedure, 37 were extraventricular drainage before/after coil embolization in subarachnoid hemorrhage patients. They all mounted conduits in their planned locations. Conclusions: A hybrid OR for combined endovascular and surgical procedures represents a safe and useful strategy for cerebrovascular disease. In hybrid ORs various neurosurgical procedures can be safely and conveniently performed. Hybrid OR will pioneer a new era in neurosurgical procedures.

Proximal basilar artery hemorrhage after submaximal angioplasty for intracranial atherosclerotic disease presenting as a large vessel occlusion treated with pipeline embolization device

Johnson Ryan M.,Young Michael,Guglielmi Gina N.,Farhat Hamad 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.2

Iatrogenic vessel perforation from endovascular intervention is a devastating complication that commonly is treated with vessel sacrifice. We present a unique case of an iatrogenic proximal basilar artery perforation after submaximal angioplasty in a 67-year-old male presenting with an acute basilar artery occlusion with underlying intracranial atherosclerotic disease. Telescoping flow-diverting stents were then deployed to reconstruct the vessel wall with resulting active hemorrhage resolution. Our case documents a successful deployment of flow-diverting stents with resolution of active hemorrhage after an iatrogenic basilar artery perforation.

Age and Meteorological Factors in the Occurrence of Spontaneous Intracerebral Hemorrhage in a Metropolitan City

김형준,김재훈,김덕령,강희인,문병관,김주성 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.3

Objective : The aim of this study was to investigate the correlation betweenmeteorological factors and occurrence of spontaneous intracerebralhemorrhage (ICH) according to age. Materials and Methods : We retrospectively analyzed the records of 735ICH patients in a metropolitan hospital-based population. Observed andexpected numbers of ICH patients were obtained at 5°C intervals of ambienttemperature and a ratio of observed to expected frequency wasthen calculated. Changes in ambient temperature from the day beforeICH onset day were observed. The Wilcoxon-Mann-Whitney test was usedto test differences in meteorological variables between the onset andnon-onset days. The Kruskal-Wallis test was used for comparison of meteorologicalvariables across gender and age. Results : ICH was observed more frequently (observed/expected ratio ≥ 1)at lower mean, minimum, and maximum ambient temperature (p = 0.0002,0.0003, and 0.0002, respectively). Significantly lower mean, minimum, andmaximum ambient temperature, dew point temperature, wind speed, andatmospheric pressure (p = 0.0003, 0.0005, 0.0001, 0.0013, 0.0431, and 0.0453,respectively) was observed for days on which spontaneous ICH occurred. In the subgroup analysis, the ICH onset day showed significantly lowermean, minimum, and maximum ambient temperature, dew point temperature,relative humidity, and higher atmospheric pressure in the older (≥65 years) female group (p = 0.0093, 0.0077, 0.0165, 0.0028, 0.0055, and0.0205, respectively). Conclusion : Occurrence of spontaneous ICH is closely associated withmeteorological factors and older females are more susceptible to lowerambient temperature.