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1.
Thanh-N. NGUYEN; Muhammad-M. QURESHI; Piers KLEIN; Hiroshi YAMAGAMI; Mohamad ABDALKADER; Robert MIKULIK; Anvitha SATHYA; Ossama-Yassin MANSOUR; Anna CZLONKOWSKA; Hannah LO; Thalia-S. FIELD; Andreas CHARIDIMOU; Soma BANERJEE; Shadi YAGHI; James-E. SIEGLER; Petra SEDOVA; Joseph KWAN; Diana-Aguiar DE-SOUSA; Jelle DEMEESTERE; Violiza INOA; Setareh-Salehi OMRAN; Liqun ZHANG; Patrik MICHEL; Davide STRAMBO; João-Pedro MARTO; Raul-G. NOGUEIRA; Espen-Saxhaug KRISTOFFERSEN; Georgios TSIVGOULIS; Virginia-Pujol LEREIS; Alice MA; Christian ENZINGER; Thomas GATTRINGER; Aminur RAHMAN; Thomas BONNET; Noémie LIGOT; Sylvie DE-RAEDT; Robin LEMMENS; Peter VANACKER; Fenne VANDERVORST; Adriana-Bastos CONFORTO; Raquel-C.T. HIDALGO; Daissy-Liliana MORA-CUERVO; Luciana DE-OLIVEIRA-NEVES; Isabelle LAMEIRINHAS-DA-SILVA; Rodrigo-Targa MARTÍNS; Letícia-C. REBELLO; Igor-Bessa SANTIAGO; Teodora SADELAROVA; Rosen KALPACHKI; Filip ALEXIEV; Elena-Adela CORA; Michael-E. KELLY; Lissa PEELING; Aleksandra PIKULA; Hui-Sheng CHEN; Yimin CHEN; Shuiquan YANG; Marina ROJE-BEDEKOVIC; Martin ČABAL; Dusan TENORA; Petr FIBRICH; Pavel DUŠEK; Helena HLAVÁČOVÁ; Emanuela HRABANOVSKA; Lubomír JURÁK; Jana KADLČÍKOVÁ; Igor KARPOWICZ; Lukáš KLEČKA; Martin KOVÁŘ; Jiří NEUMANN; Hana PALOUŠKOVÁ; Martin REISER; Vladimir ROHAN; Libor ŠIMŮNEK; Ondreij SKODA; Miroslav ŠKORŇA; Martin ŠRÁMEK; Nicolas DRENCK; Khalid SOBH; Emilie LESAINE; Candice SABBEN; Peggy REINER; Francois ROUANET; Daniel STRBIAN; Stefan BOSKAMP; Joshua MBROH; Simon NAGEL; Michael ROSENKRANZ; Sven POLI; Götz THOMALLA; Theodoros KARAPANAYIOTIDES; Ioanna KOUTROULOU; Odysseas KARGIOTIS; Lina PALAIODIMOU; José-Dominguo BARRIENTOS-GUERRA; Vikram HUDED; Shashank NAGENDRA; Chintan PRAJAPATI; P.N. SYLAJA; Achmad-Firdaus SANI; Abdoreza GHOREISHI; Mehdi FARHOUDI; Elyar SADEGHI-HOKMABADI; Mazyar HASHEMILAR; Sergiu-Ionut SABETAY; Fadi RAHAL; Maurizio ACAMPA; Alessandro ADAMI; Marco LONGONI; Raffaele ORNELLO; Leonardo RENIERI; Michele ROMOLI; Simona SACCO; Andrea SALMAGGI; Davide SANGALLI; Andrea ZINI; Kenichiro SAKAI; Hiroki FUKUDA; Kyohei FUJITA; Hirotoshi IMAMURA; Miyake KOSUKE; Manabu SAKAGUCHI; Kazutaka SONODA; Yuji MATSUMARU; Nobuyuki OHARA; Seigo SHINDO; Yohei TAKENOBU; Takeshi YOSHIMOTO; Kazunori TOYODA; Takeshi UWATOKO; Nobuyuki SAKAI; Nobuaki YAMAMOTO; Ryoo YAMAMOTO; Yukako YAZAWA; Yuri SUGIURA; Jang-Hyun BAEK; Si-Baek LEE; Kwon-Duk SEO; Sung-Il SOHN; Jin-Soo LEE; Anita-Ante ARSOVSKA; Chan-Yong CHIEH; Wan-Asyraf WAN-ZAIDI; Wan-Nur-Nafisah WAN-YAHYA; Fernando GONGORA-RIVERA; Manuel MARTINEZ-MARINO; Adrian INFANTE-VALENZUELA; Diederik DIPPEL; Dianne-H.K. VAN-DAM-NOLEN; Teddy-Y. WU; Martin PUNTER; Tajudeen-Temitayo ADEBAYO; Abiodun-H. BELLO; Taofiki-Ajao SUNMONU; Kolawole-Wasiu WAHAB; Antje SUNDSETH; Amal-M. AL-HASHMI; Saima AHMAD; Umair RASHID; Liliana RODRIGUEZ-KADOTA; Miguel-Ángel VENCES; Patrick-Matic YALUNG; Jon-Stewart-Hao DY; Waldemar BROLA; Aleksander DĘBIEC; Malgorzata DOROBEK; Michal-Adam KARLINSKI; Beata-M. LABUZ-ROSZAK; Anetta LASEK-BAL; Halina SIENKIEWICZ-JAROSZ; Jacek STASZEWSKI; Piotr SOBOLEWSKI; Marcin WIĄCEK; Justyna ZIELINSKA-TUREK; André-Pinho ARAÚJO; Mariana ROCHA; Pedro CASTRO; Patricia FERREIRA; Ana-Paiva NUNES; Luísa FONSECA; Teresa PINHO-E-MELO; Miguel RODRIGUES; M-Luis SILVA; Bogdan CIOPLEIAS; Adela DIMITRIADE; Cristian FALUP-PECURARIU; May-Adel HAMID; Narayanaswamy VENKETASUBRAMANIAN; Georgi KRASTEV; Jozef HARING; Oscar AYO-MARTIN; Francisco HERNANDEZ-FERNANDEZ; Jordi BLASCO; Alejandro RODRÍGUEZ-VÁZQUEZ; Antonio CRUZ-CULEBRAS; Francisco MONICHE; Joan MONTANER; Soledad PEREZ-SANCHEZ; María-Jesús GARCÍA-SÁNCHEZ; Marta GUILLÁN-RODRÍGUEZ; Gianmarco BERNAVA; Manuel BOLOGNESE; Emmanuel CARRERA; Anchalee CHUROJANA; Ozlem AYKAC; Atilla-Özcan ÖZDEMIR; Arsida BAJRAMI; Songul SENADIM; Syed-I. HUSSAIN; Seby JOHN; Kailash KRISHNAN; Robert LENTHALL; Kaiz-S. ASIF; Kristine BELOW; Jose BILLER; Michael CHEN; Alex CHEBL; Marco COLASURDO; Alexandra CZAP; Adam-H. DE-HAVENON; Sushrut DHARMADHIKARI; Clifford-J. ESKEY; Mudassir FAROOQUI; Steven-K. FESKE; Nitin GOYAL; Kasey-B. GRIMMETT; Amy-K. GUZIK; Diogo-C. HAUSSEN; Majesta HOVINGH; Dinesh JILLELA; Peter-T. KAN; Rakesh KHATRI; Naim-N. KHOURY; Nicole-L. KILEY; Murali-K. KOLIKONDA; Stephanie LARA; Grace LI; Italo LINFANTE; Aaron-I. LOOCHTAN; Carlos-D. LOPEZ; Sarah LYCAN; Shailesh-S. MALE; Fadi NAHAB; Laith MAALI; Hesham-E. MASOUD; Jiangyong MIN; Santiago ORGETA-GUTIERREZ; Ghada-A. MOHAMED; Mahmoud MOHAMMADEN; Krishna NALLEBALLE; Yazan RADAIDEH; Pankajavalli RAMAKRISHNAN; Bliss RAYO-TARANTO; Diana-M. ROJAS-SOTO; Sean RULAND; Alexis-N. SIMPKINS; Sunil-A. SHETH; Amy-K. STAROSCIAK; Nicholas-E. TARLOV; Robert-A. TAYLOR; Barbara VOETSCH; Linda ZHANG; Hai-Quang DUONG; Viet-Phuong DAO; Huynh-Vu LE; Thong-Nhu PHAM; Mai-Duy TON; Anh-Duc TRAN; Osama-O. ZAIDAT; Paolo MACHI; Elisabeth DIRREN; Claudio RODRÍGUEZ-FERNÁNDEZ; Jorge ESCARTÍN-LÓPEZ; Jose-Carlos FERNÁNDEZ-FERRO; Niloofar MOHAMMADZADEH; Neil-C. SURYADEVARA,-MD; Beatriz DE-LA-CRUZ-FERNÁNDEZ; Filipe BESSA; Nina JANCAR; Megan BRADY; Dawn SCOZZARI.
Journal of Stroke ; : 256-265, 2022.
Article in English | WPRIM | ID: wpr-938173

ABSTRACT

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

2.
Journal of Stroke ; : 244-252, 2021.
Article in English | WPRIM | ID: wpr-900644

ABSTRACT

Background@#and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. @*Methods@#Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. @*Results@#Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). @*Conclusions@#The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

3.
Article in English | WPRIM | ID: wpr-874683

ABSTRACT

Background@#and Purpose We aimed to determine whether the care process and outcomes in patients with acute stroke who received recanalization therapy changed during the outbreak of coronavirus disease 2019 (COVID-19) in South Korea. @*Methods@#We used data from a prospective multicenter reperfusion therapy registry to compare the care process including the time from symptom onset to treatment, number of treated patients, and discharge disposition and treatment outcomes between before and during the COVID-19 outbreak in South Korea. @*Results@#Upon the COVID-19 outbreak in South Korea, the number of patients receiving endovascular treatment to decrease temporarily but considerably. The use of emergency medical services by stroke patients increased from 91.5% before to 100.0% during the COVID-19 outbreak (p=0.025), as did the median time from symptom onset to hospital visit [median (interquartile range), 91.0 minutes (39.8–277.0) vs. 176.0 minutes (56.0–391.5), p=0.029]. Furthermore, more functionally dependent patients with disabilities were discharged home (59.5% vs. 26.1%, p=0.020) rather than staying in a regional or rehabilitation hospital. In contrast, there were no COVID-19-related changes in the times from the hospital visit to brain imaging and treatment or in the functional outcome, successful recanalization rate, or rate of symptomatic intracerebral hemorrhage. @*Conclusions@#These findings suggest that a prehospital delay occurred during the COVID-19 outbreak, and that patients with acute stroke might have been reluctant to visit and stay in hospitals. Our findings indicate that attention should be paid to prehospital care and the behavior of patients with acute stroke during the COVID-19 outbreak.

4.
Journal of Stroke ; : 244-252, 2021.
Article in English | WPRIM | ID: wpr-892940

ABSTRACT

Background@#and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. @*Methods@#Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. @*Results@#Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). @*Conclusions@#The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

5.
Neurointervention ; : 82-90, 2019.
Article in English | WPRIM | ID: wpr-760599

ABSTRACT

PURPOSE: Although carotid endarterectomy (CEA) is recommended as a treatment for carotid stenosis rather than carotid artery stenting (CAS), CAS has been preferred in Korea. The aim of this study was to analyze long-term outcomes after CAS compared with CEA using Korean nationwide insurance data. MATERIALS AND METHODS: We obtained all data from the nationwide database of the Health Insurance Review & Assessment Service (HIRA) during the study period using several codes regarding the procedure or operation. We included the HIRA data, which included at least one-year follow-up after the procedures. The outcomes associated with both procedures were death, recurrence of ischemic stroke, and admission for cerebral hemorrhage. RESULTS: A total of 16,065 eligible patients who were treated with CAS or CEA between 1 January 2007 and 31 December 2016 were analyzed. The number of patients with CAS and CEA was 12,173 (75.8%) and 3,892 (24.2%), respectively. 8,976 patients (55.9%) were classified as symptomatic patients. CAS was associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.282; 95% confidence interval [CI], 1.173–1.400). The adjusted rates for recurrent ischemic stroke and cerebral hemorrhage between CAS versus CEA were 24.9% versus 15.9% (HR, 1.474; 95% CI, 1.325–1.639) and 1.5% versus 0.9% (HR, 2.026; 95% CI, 1.322–3.106), respectively. In young symptomatic patients, there was no statistically significant difference in all-cause mortality and cardiovascular death between CAS and CEA. CONCLUSION: Our study using Korean nationwide insurance data demonstrated similar results to previous studies. Until further evidence of CAS is established through prospective studies, CAS should be performed in selected patients according to current guidelines.


Subject(s)
Carotid Arteries , Carotid Stenosis , Cerebral Hemorrhage , Endarterectomy , Endarterectomy, Carotid , Follow-Up Studies , Humans , Insurance , Insurance, Health , Korea , Mortality , Prognosis , Prospective Studies , Recurrence , Stents , Stroke
6.
Article in English | WPRIM | ID: wpr-718819

ABSTRACT

BACKGROUND AND PURPOSE: Previous studies have reported conflicting results about the prevalence of seizures in Alzheimer's disease (AD). There are few epidemiological studies on this topic in Asia. Thus, the objective of this study was to examine demographic and clinical characteristics as well as incidence for seizures in AD patients compared to non-AD patients in a prospective, longitudinal, community-based cohort with a long follow-up. METHODS: Data were collected from National Health Insurance Service-National Elderly Cohort (NHIS-elderly) Database to define patients with AD from 2004–2006 using Korean Classification Diseases codes G30 and F00. We performed a 1:5 case-control propensity score matching based on age, sex, and household income. We conducted Cox proportional hazards regression analysis to estimate the risk of epilepsy in AD patients. RESULTS: In the cohort study, patients with AD had higher risk for epilepsy than those without AD, with hazard ratio of 2.773 (95% confidence interval [CI], 2.515–3.057). This study also showed that male gender and comorbidities such as hypertension, hyperlipidemia, diabetes, and chronic kidney disease increased the risk of developing epilepsy. Patients with AD had 1.527 (95% CI, 1.375–1.695) times higher mortality rate than those in the control group. CONCLUSIONS: AD patients have significantly higher risk of developing epilepsy than non-AD patients.


Subject(s)
Aged , Alzheimer Disease , Asia , Case-Control Studies , Classification , Cohort Studies , Comorbidity , Epidemiologic Studies , Epilepsy , Family Characteristics , Follow-Up Studies , Humans , Hyperlipidemias , Hypertension , Incidence , Male , Mortality , National Health Programs , Prevalence , Propensity Score , Prospective Studies , Renal Insufficiency, Chronic , Seizures
7.
Article in Korean | WPRIM | ID: wpr-766676

ABSTRACT

Secondary degeneration after ischemic stroke has been demonstrated by computed tomography and magnetic resonance imaging. We report a 77-year-old man with striatal infarction followed by multifocal degeneration that developed in a stepwise manner at the ipsilateral substantia nigra and thalamus on diffusion-weighted images obtained at 4 weeks, 6 weeks and 20 weeks after onset. We also review the underlying pathophysiology and its clinical meanings.


Subject(s)
Aged , Cerebral Infarction , Humans , Infarction , Magnetic Resonance Imaging , Stroke , Substantia Nigra , Thalamus
8.
Neurointervention ; : 84-89, 2018.
Article in English | WPRIM | ID: wpr-730260

ABSTRACT

PURPOSE: As endovascular therapy (EVT) has been approved as a treatment guideline for acute ischemic stroke (AIS), it has been increasing in Korea. We conducted a nationwide survey to evaluate the current status of EVT for patients with AIS in Korea. MATERIALS AND METHODS: An electronic survey was sent to a representative clinician at each hospital where EVT was available in Korea. A Google survey was used to distribute the questionnaires and receive responses from October 2017 to December 2017. RESULTS: Among 120 hospitals in our society, 76 participated in this survey. In 26% of the hospitals, more than 50 annual cases of EVT were performed, and 25–50 annual cases in 37%. Fifty-six hospitals (73.7%) achieved successful recanalization (thrombolysis in cerebral infarction ≥2b) in more than 80% of patients. Computed tomography (CT) angiography was the most common imaging modality for AIS treatment, and magnetic resonance (MR) diffusion, MR-perfusion/diffusion, and perfusion CT were frequently used in order. Non-eligibility criteria for EVT included a National Institutes of Health Stroke Scale < 4 (64.5%), the absence of MR perfusion/diffusion mismatch (52.6%), and a low Alberta Stroke Program Early CT Score (42.1%). For anterior circulation stroke, 60% of Korean hospitals adopted a wider time range of “8 hours” from symptom onset, while 70% of hospitals had a time limitation of 12–24 hours for posterior circulation stroke. The most preferred EVT device was a stentriever (89.4%). In the failed cases due to underlying stenosis, 79% of Korean hospitals performed angioplasty or stenting for revascularization. CONCLUSION: This first nationwide survey showed that most Korean hospitals conducted EVT for AIS patients according to the present guideline in the era of mechanical thrombectomy by integrating the clinical experiences of many medical institutions and specialists.


Subject(s)
Alberta , Angiography , Angioplasty , Cerebral Infarction , Constriction, Pathologic , Diffusion , Humans , Ischemia , Korea , Perfusion , Specialization , Stents , Stroke , Thrombectomy
9.
Yonsei Medical Journal ; : 1322-1327, 2015.
Article in English | WPRIM | ID: wpr-185888

ABSTRACT

PURPOSE: Leptomeningeal collateral, in moyamoya disease (MMD), appears as an ivy sign on fluid-attenuated inversion-recovery (FLAIR) images. There has been little investigation into the relationship between presentation of ivy signs and old brain lesions. We aimed to evaluate clinical significance of ivy signs and whether they correlate with old brain lesions and the severity of clinical symptoms in patients with MMD. MATERIALS AND METHODS: FLAIR images of 83 patients were reviewed. Each cerebral hemisphere was divided into 4 regions and each region was scored based on the prominence of the ivy sign. Total ivy score (TIS) was defined as the sum of the scores from the eight regions and dominant hemispheric ivy sign (DHI) was determined by comparing the ivy scores from each hemisphere. According to the degree of ischemic symptoms, patients were classified into four subgroups: 1) nonspecific symptoms without motor weakness, 2) single transient ischemic attack (TIA), 3) recurrent TIA, or 4) complete stroke. RESULTS: TIS was significantly different as follows: 4.86+/-2.55 in patients with nonspecific symptoms, 5.89+/-3.10 in patients with single TIA, 9.60+/-3.98 in patients with recurrent TIA and 8.37+/-3.39 in patients with complete stroke (p=0.003). TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35+/-4.22 vs. 7.49+/-3.37, p=0.032). We found a significant correlation between DHI and motor symptoms (p=0.001). CONCLUSION: Because TIS has a strong tendency with severity of ischemic motor symptom and the presence of old lesions, the ivy sign may be useful in predicting severity of disease progression.


Subject(s)
Adolescent , Adult , Aged , Brain/metabolism , Cerebral Arteries/pathology , Child , Child, Preschool , Collateral Circulation , Disease Progression , Female , Humans , Magnetic Resonance Imaging/methods , Male , Meninges/pathology , Middle Aged , Moyamoya Disease/complications , Severity of Illness Index , Stroke , Young Adult
10.
Article in English | WPRIM | ID: wpr-34160

ABSTRACT

OBJECTIVE: There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. MATERIALS AND METHODS: A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. RESULTS: CEA or CAS is indicated when the patient has a symptomatic stenosis > or = 50%, or when the patient has an asymptomatic stenosis > or = 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. CONCLUSION: We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.


Subject(s)
Carotid Arteries , Carotid Stenosis , Constriction, Pathologic , Endarterectomy, Carotid , Humans , Stents
12.
Yonsei Medical Journal ; : 683-688, 2014.
Article in English | WPRIM | ID: wpr-58589

ABSTRACT

PURPOSE: Clopidogrel is metabolized by the hepatic cytochrome P450 (CYP) system into its active thiol metabolite. CYP3A4 is involved in the metabolism of both clopidogrel and dihydropyridine calcium channel blockers (CCBs). A few reports have suggested an inhibitory interaction between CCBs and clopidogrel. Accordingly, the aim of this study was to determine the effect of CCBs on the antiplatelet activity of clopidogrel by serial P2Y12 reaction unit (PRU) measurements. MATERIALS AND METHODS: We assessed changes in antiplatelet activity in patients receiving both clopidogrel and CCBs for at least 2 months prior to enrollment in the study. The antiplatelet activity of clopidogrel was measured by VerifyNow P2Y12 assay in the same patient while medicated with CCBs and at 8 weeks after discontinuation of CCBs. After discontinuation of the CCBs, angiotensin receptor blockers were newly administered to the patients or dosed up for control of blood pressure. RESULTS: Thirty patients finished this study. PRU significantly decreased after discontinuation of CCBs (238.1+/-74.1 vs. 215.0+/-69.3; p=0.001). Of the 11 patients with high post-treatment platelet reactivity to clopidogrel (PRU> or =275), PRU decreased in nine patients, decreasing below the cut-off value in seven of these nine patients after 8 weeks. Decrease in PRU was not related to CYP2C19 genotype. CONCLUSION: CCBs inhibit the antiplatelet activity of clopidogrel.


Subject(s)
Aged , Aged, 80 and over , Blood Platelets/drug effects , Calcium Channel Blockers/therapeutic use , Dihydropyridines/therapeutic use , Drug Interactions , Female , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives
13.
Article in English | WPRIM | ID: wpr-228618

ABSTRACT

We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.


Subject(s)
Aged , Anticoagulants/therapeutic use , Carotid Arteries/diagnostic imaging , Cerebral Infarction/diagnosis , Humans , Male , Platelet Aggregation Inhibitors/therapeutic use , Stents/adverse effects , Thrombosis/drug therapy , Ticlopidine/analogs & derivatives , Tomography, X-Ray Computed
14.
Neurointervention ; : 80-86, 2013.
Article in English | WPRIM | ID: wpr-730214

ABSTRACT

PURPOSE: The purpose of this study is to present our preliminary experience of the temporary endovascular bypass (TEB) technique using an Enterprise stent for recanalization of acute intracranial artery (IA) occlusion. MATERIALS AND METHODS: Patients treated by TEB were enrolled in this retrospective study from January 2009 to May 2010. All the procedures consist of temporary partial deployment and subsequent retrieval of Enterprise stent, supplemented by intra-arterial infusion of urokinase (UK) and/or tirofiban. According to the thrombolysis in cerebral infarction (TICI) classification, recanalization was evaluated with initial and postprocedural angiography. Safety was evaluated related to the procedure and clinical outcomes were assessed by National Institute of Health Stroke Scale (NIHSS) score at discharge and modified Rankin scale (mRS) score at 3 months. RESULTS: Eleven patients (median NIHSS 12.8, mean age 61.6 years, male: female = 8:3) with acute IA occlusion were treated with TEB. All the patients presented with TICI 0, and the occluded vessel was the middle cerebral artery (n=7), the basilar artery (n=1), and the distal ICA occlusion (n = 3). IV infusion of tissue plasminogen activator (tPA) was done in 4 patients and mechanical thrombolysis with intra-arterial UK was performed in 9. Recanalization was achieved in 73% (8 patients; TICI > or = 2). There were no procedure-related complications except for two asymptomatic intracranial hemorrhages. Improvement (> or = 4 points on the NIHSS) and good outcome (mRS < or =2) after 90 days was shown in six patients (55%). One patient died 6 days after procedure. CONCLUSION: TEB may be a valuable treatment option in acute thromboembolic IA occlusion without stent implantation.


Subject(s)
Angiography , Arteries , Basilar Artery , Cerebral Infarction , Female , Glycosaminoglycans , Humans , Infusions, Intra-Arterial , Intracranial Hemorrhages , Mechanical Thrombolysis , Middle Cerebral Artery , Retrospective Studies , Stents , Stroke , Tissue Plasminogen Activator , Tyrosine , Urokinase-Type Plasminogen Activator
15.
Article in Korean | WPRIM | ID: wpr-14871

ABSTRACT

Several new antithrombotic drugs have been developed and approved to use in clinical practice recently. Dabigatran, a direct thrombin inhibitor, and rivaroxaban, a factor Xa inhibitor, have been approved in many countries including Korea to prevent stroke in patient with atrial fibrillation. Apixaban, another factor Xa inhibitor, showed good results in clinical trial and is waiting for approval for clinical use. New antiplatelet agent, terutroban, selective thromboxane A2 receptor inhibitor, failed to prove the efficacy over the aspirin in secondary stroke prevention. Vorapaxar, a new antiplatelet agent that inhibits thrombin through PAR-1 antagonism, showed a high incidence of intracranial hemorrhage in patient with a history of stroke.


Subject(s)
Aspirin , Atrial Fibrillation , Benzimidazoles , beta-Alanine , Factor Xa , Humans , Incidence , Intracranial Hemorrhages , Korea , Lactones , Morpholines , Naphthalenes , Propionates , Pyrazoles , Pyridines , Pyridones , Receptors, Thromboxane A2, Prostaglandin H2 , Stroke , Thiophenes , Thrombin , Dabigatran , Rivaroxaban
16.
Yonsei Medical Journal ; : 933-938, 2011.
Article in English | WPRIM | ID: wpr-30299

ABSTRACT

PURPOSE: Changes in electroencephalography (EEG) patterns may offer a clue to the cause of altered mental status and suggest the prognoses of patients with such mental status. We aimed to identify the EEG patterns in patients with altered mental status and to correlate EEG findings with clinical prognoses. MATERIALS AND METHODS: We included 105 patients with altered mental status who underwent EEG. EEG and clinical chart reviews with ongoing patient follow-ups were performed to determine the clinical prognosis of the patients. Clinical data were sorted using the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS). EEG findings were classified according to a method suggested by Scollo-Lavizzari. The EEGs were analyzed to find out whether any correlation existed with the prognoses of patients. RESULTS: Nonconvulsive status epilepticus (NCSE) was detected in only three patients (2.9%). Specific EEG patterns were observed in 28 patients. Twenty-nine (27.6%) patients expired, and 45 (42.9%) patients were in a vegetative state. EEG grade and GCS significantly correlated with GOS. EEG grade alone had a correlation with GCS. Patients with a severe EEG finding had a poor prognosis. CONCLUSION: EEG findings reflect the mental status of patients, and EEG grades are correlated with the clinical prognosis of patients. Although EEG is not frequently performed on patients with altered mental state, it can play a supplemental role in establishing a prognosis. Thus, the use of EEG should be emphasized in clinical setting.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Electroencephalography/methods , Epilepsy, Generalized/diagnosis , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
17.
Article in Korean | WPRIM | ID: wpr-70321

ABSTRACT

BACKGROUND: Facioscapulohumeral muscular dystrophy (FSHD) is associated with contractions of the polymorphic D4Z4-repeat array in 4q35 and has the distinctive clinical presentation of an initial involvement of the facial, shoulder-girdle, and upper-arm muscles. The aim of the present study was to determine clinical characteristics in Korean patients with FSHD and potential relationships between contracted D4Z4-repeat size and the FSHD phenotype. METHODS: We studied 34 genetically confirmed patients who had repeat sizes less than 38 kb, and analyzed their clinical manifestations with a structured protocol. The expressed phenotypes were scored according to the Clinical Severity Score formulated by Ricci and van Overveld. RESULTS: The clinical spectrum ranged widely, from asymptomatic individuals with minimal signs to wheelchair- bound patients. The initial affects were mainly in the facial muscles (68.8%), followed by the shoulder-girdle muscle (28.1%). Asymmetric features of the face and shoulder girdle were also important findings (71.9% and 90.0%, respectively). Winging scapular (87.5%), transverse smile (84.4%), Beevor's sign (68.8%), and sleeping with eyes opened (59.4%) were clinically important signs. There was a significant negative correlation between repeat size and clinical severity (r=-0.38, p=0.03). CONCLUSIONS: Distinctive clinical characteristics of FSHD are descending progression and asymmetric distribution of the muscle weakness. Our results also confirmed that the severity of FSHD increases with decreasing D4Z4-repeat size.


Subject(s)
Contracts , Eye , Facial Muscles , Genotype , Humans , Muscle Weakness , Muscles , Muscular Dystrophies , Muscular Dystrophy, Facioscapulohumeral , Phenotype , Shoulder
18.
Yonsei Medical Journal ; : 163-166, 2008.
Article in English | WPRIM | ID: wpr-158185

ABSTRACT

Carotid artery stenting is widely performed for extracranial carotid artery stenosis. In-stent thrombosis is a rare but potentially devastating complication. We present a case of acute in-stent thrombosis immediately following stent insertion and post-balloon dilatation in a 64-year-old male. Thrombosis was successfully treated by intravenous tirofiban, a glycoprotein IIb/IIIa receptor inhibitor.


Subject(s)
Acute-Phase Reaction/drug therapy , Angiography , Carotid Artery Diseases/drug therapy , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Stents , Thrombosis/drug therapy , Tyrosine/analogs & derivatives
19.
Article in Korean | WPRIM | ID: wpr-113737

ABSTRACT

Neurodegeneration with brain iron accumulation (NBIA) is a disorder characterized by various mixtures of extrapyramidal, pyramidal or psychiatric abnormalities associated with iron accumulation in the basal ganglia. The mutations in the pantothenate kinase gene (PANK2) were found in approximately two thirds of the patients with NBIA. We report three patients wtih NBIA, and two of them showed mutations in the PANK2 gene.


Subject(s)
Basal Ganglia , Brain , Humans , Iron , Iron Metabolism Disorders , Neuroaxonal Dystrophies , Phosphotransferases , Phosphotransferases (Alcohol Group Acceptor)
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