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1.
Journal of Stroke ; : 179-186, 2016.
Article in English | WPRIM | ID: wpr-113530

ABSTRACT

BACKGROUND AND PURPOSE: The outcomes of acute internal carotid artery (ICA) terminus occlusions are poor. We classified ICA terminus occlusions into 2 groups according to the occlusion pattern of the circle of Willis and hypothesized that clinical outcomes would significantly differ between them. METHODS: Consecutive patients with acute ICA terminus occlusions evaluated by baseline computed tomographic angiography were enrolled. We investigated the occlusion patterns in the circle of Willis, retrospectively classified patients into simple ICA terminus occlusion (STO; with good Willisian collaterals from neighboring cerebral circulation) and complex ICA terminus occlusion (CTO; with one or more of A2 anterior cerebral artery, fetal posterior cerebral artery occlusion, or hypoplastic/absent contralateral A1; or with poor collaterals from anterior communicating artery) groups, and compared their baseline characteristics and outcomes. RESULTS: The STO group (n=58) showed smaller infarct volumes at 72 hours than the CTO group (n=34) (median, 81 mL [interquartile range, 38-192] vs. 414 mL [193-540], P<0.001) and more favorable outcomes (3-month modified Rankin Scale 0-3, 44.8% vs. 8.8%, P<0.001; 3-month mortality, 24.1% vs. 67.6%, P<0.001). In multivariable analyses, STO remained an independent predictor for favorable outcomes (odds ratio 6.1, P=0.010). CONCLUSIONS: Favorable outcomes in STO group suggested that the outcomes of acute ICA terminus occlusions depend on Willisian collateral status. Documenting the subtypes on computed tomographic angiography would help predict patient outcome.


Subject(s)
Angiography , Anterior Cerebral Artery , Carotid Artery Thrombosis , Carotid Artery, Internal , Cerebral Infarction , Circle of Willis , Collateral Circulation , Endovascular Procedures , Humans , Mortality , Posterior Cerebral Artery , Retrospective Studies
2.
Journal of Stroke ; : 96-101, 2016.
Article in English | WPRIM | ID: wpr-135879

ABSTRACT

BACKGROUND AND PURPOSE: The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion. METHODS: Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. RESULTS: Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective. CONCLUSIONS: Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.


Subject(s)
Angioplasty , Arteries , Cerebral Infarction , Constriction, Pathologic , Embolism , Humans , Intracranial Arteriosclerosis , Intracranial Embolism and Thrombosis , Mechanical Thrombolysis , Stents , Thrombectomy
3.
Journal of Stroke ; : 96-101, 2016.
Article in English | WPRIM | ID: wpr-135874

ABSTRACT

BACKGROUND AND PURPOSE: The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion. METHODS: Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. RESULTS: Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective. CONCLUSIONS: Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.


Subject(s)
Angioplasty , Arteries , Cerebral Infarction , Constriction, Pathologic , Embolism , Humans , Intracranial Arteriosclerosis , Intracranial Embolism and Thrombosis , Mechanical Thrombolysis , Stents , Thrombectomy
4.
Korean Journal of Medicine ; : 371-373, 2012.
Article in Korean | WPRIM | ID: wpr-741072

ABSTRACT

Linezolid has been used for treatment of vancomycin-resistant Enterococcus faecium infection, nosocomial pneumonia caused by Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus or Streptococcus pneumoniae, and complicated and uncomplicated skin and skin structure infections. Lactic acidosis is an adverse effect associated with drugs, including metformin, the nucleoside reverse-transcriptase inhibitors and, rarely, linezolid. We report a case in which severe lactic acidosis developed as an adverse effect of linezolid in a 75-year-old woman who had been on linezolid for 30 days for treatment of a wound infection caused by methicillin-resistant coagulase-negative Staphylococcus. Discontinuation of linezolid and hemodialysis improved her lactic acidosis.


Subject(s)
Acetamides , Acidosis, Lactic , Aged , Cross Infection , Enterococcus faecium , Female , Humans , Metformin , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Oxazolidinones , Pneumonia , Renal Dialysis , Skin , Staphylococcus , Staphylococcus aureus , Streptococcus pneumoniae , Wound Infection , Linezolid
5.
Article in Korean | WPRIM | ID: wpr-211782

ABSTRACT

A 33-year-old male was admitted with severe headache lasting 3 days. He did not have a focal neurologic deficit, but had a high intracranial pressure of 512 mmH2O. Cerebral angiography revealed venous sinus thrombosis that mainly involved the superior sagittal and right transverse sinuses. His headache remained severe after intravenous heparin infusion, and so interventional procedures were performed. Mechanical aspiration with the Penumbra system(TM) and other interventional procedures reopened the outflow of the superior sagittal sinus and effectively ameliorated this patient's headache.


Subject(s)
Adult , Cerebral Angiography , Headache , Heparin , Humans , Intracranial Pressure , Male , Neurologic Manifestations , Sagittal Sinus Thrombosis , Sinus Thrombosis, Intracranial , Suction , Superior Sagittal Sinus , Thrombectomy , Thrombolytic Therapy , Transverse Sinuses , Venous Thrombosis
6.
Article in English | WPRIM | ID: wpr-145566

ABSTRACT

OBJECTIVE: The purpose of this study was to elucidate the anatomical development of physiologic suture closure processes in infants using three dimensional reconstructed computed tomography (CT). METHODS: A consecutive series of 243 infants under 12 months of age who underwent three dimensional CT were included in this study. Four major cranial sutures (sagittal, coronal, lambdoidal and metopic suture) were classified into four suture closure grades (grade 0=no closure along the whole length, grade 1=partial or intermittent closure, grade 2=complete closure with visible suture line, grade 3=complete fusion (ossification) without visible suture line), and measured for its closure degree (suture closure rates; defined as percentage of the length of closed suture line divided by the total length of suture line). RESULTS: Suture closure grade under 12 months of age comprised of grade 0 (n=195, 80.2%), grade 1 (n=24, 9.9%) and grade 2 (n=24, 9.9%) in sagittal sutures, whereas in metopic sutures they were grade 0 (n=61, 25.1%), grade 1 (n=167, 68.7%), grade 2 (n=6, 24%) and grade 3 (n=9, 3.7%). Mean suture closure rates under 12 months of age was 58.8% in metopic sutures, followed by coronal (right : 43.8%, left : 41.1%), lambdoidal (right : 27.2%, left : 25.6%) and sagittal sutures (15.6%), respectively. CONCLUSION: These quantitative descriptions of cranial suture closure may help understand the process involved in the cranial development of Korean infants.


Subject(s)
Cranial Sutures , Growth and Development , Humans , Infant , Sutures
7.
Korean Journal of Medicine ; : 371-373, 2012.
Article in Korean | WPRIM | ID: wpr-148196

ABSTRACT

Linezolid has been used for treatment of vancomycin-resistant Enterococcus faecium infection, nosocomial pneumonia caused by Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus or Streptococcus pneumoniae, and complicated and uncomplicated skin and skin structure infections. Lactic acidosis is an adverse effect associated with drugs, including metformin, the nucleoside reverse-transcriptase inhibitors and, rarely, linezolid. We report a case in which severe lactic acidosis developed as an adverse effect of linezolid in a 75-year-old woman who had been on linezolid for 30 days for treatment of a wound infection caused by methicillin-resistant coagulase-negative Staphylococcus. Discontinuation of linezolid and hemodialysis improved her lactic acidosis.


Subject(s)
Acetamides , Acidosis, Lactic , Aged , Cross Infection , Enterococcus faecium , Female , Humans , Metformin , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Oxazolidinones , Pneumonia , Renal Dialysis , Skin , Staphylococcus , Staphylococcus aureus , Streptococcus pneumoniae , Wound Infection , Linezolid
8.
Asian Spine Journal ; : 118-122, 2010.
Article in English | WPRIM | ID: wpr-33264

ABSTRACT

We report here on a case of a 23-year-old male who received en block spondylectomy for a vertebral Ewing's sarcoma at our hospital. Nine days after surgery, he presented with severe back pain and motor weakness of the lower extremities. Based on the physical examination and the computed tomography scan, he was diagnosed with acute cauda equina syndrome that was caused by compression from an epidural hematoma. His neurological functions recovered after emergency evacuation of the hematoma. This case showed that extensive surgery for a malignant vertebral tumor has a potential risk of delayed epidural hematoma and acute cauda equina syndrome and this should be treated with emergency evacuation.


Subject(s)
Back Pain , Emergencies , Hematoma , Hematoma, Epidural, Spinal , Humans , Lower Extremity , Male , Physical Examination , Polyradiculopathy , Sarcoma, Ewing , Spine , Young Adult
9.
Neurointervention ; : 23-31, 2010.
Article in English | WPRIM | ID: wpr-730339

ABSTRACT

OBJECTIVE: To correlate quantitative cerebrovascular reserve calculated by acetazolamide - challenged CT perfusion with clinical symptoms in hemodynamically compromised patients with high-grade (>70%) carotid stenosis, who did not have evidence of embolic stroke. MATERIALS AND METHODS: 37 patients diagnosed as unilateral severe carotid stenosis and 10 age-matched normal controls underwent acetazolamide - challenged CT perfusion. For quantitative measurement, asymmetric index of cerebral blood flow, cerebral blood volume, and mean transit time were determined before and after acetazolamide challenge. Reactivity index was also calculated from asymmetric index of cerebral blood flow before and after acetazolamide challenge. RESULTS: On visual analysis, all of 14 asymptomatic patients and 4 of 23 symptomatic patients showed bilateral symmetric cerebrovascular reserve on CT perfusion, and 19 symptomatic patients showed decreased cerebrovascular reserve ipsilateral to carotid stenosis. On quantitative analysis, the reactivity index was significantly different between the symptomatic and the asymptomatic groups (-24% vs -8% in external border zone) but the resting parameters were not. 11 patients with decreased cerebrovascular reserve who underwent carotid stenting showed improved clinical symptoms and quantitative cerebrovascular reserve on follow up CT perfusion. CONCLUSION: Compared with resting hemodynamic parameters, quantitative cerebrovascular reserve calculated by CT perfusion is most significantly correlated with clinical symptoms in hemodynamically compromised patients with high-grade carotid stenosis.


Subject(s)
Acetazolamide , Blood Volume , Carotid Stenosis , Follow-Up Studies , Hemodynamics , Humans , Perfusion , Stents
10.
Article in Korean | WPRIM | ID: wpr-149512

ABSTRACT

PURPOSE: The purpose of this study was to determine the effect of curettage and DBM complex graft as a new treatment modality for LCP disease using piglet capital femoral epiphysis ischemic necrosis model. MATERIALS AND METHODS: Five to six weeks old piglets were used for the experiment. Ischemic necrosis of the capital femoral epiphysis was surgically induced by cervical ligation on both sides. Three weeks following ischemic insult, the left hip joint was approached medially. About 15% of the necrotic capital femoral epiphysis was curetted through a window which was opened at medial cervical cortex, then, demineralized bone matrix complex was engrafted. The right femoral heads served as controls. Piglets were sacrificed three, six, nine, and twelve weeks following were harvested for histologic examination. RESULTS: In control group, photomicrographs of specimens showed central necrosis and fibrovascular invasion in capital femoral necrosis at three weeks after ischemic insult. Six, nine, and twelve weeks following ischemic insult, fibrovascular invasion advanced without noticeable new bone formation and collapse of femoral head progressed. At twelve weeks, definite coxa plana developed. In curettage and DBM complex graft group, there was evident new bone formation observed in the site of DBM complex graft. At three weeks, new bone formation along with fibrovascular invasion was observed around the engrafted DBM complex mainly in the cervical metaphyseal area. At six and nine weeks, new bone formation progressed into the engrafted DBM complex in the cervical metaphysis and around the engrafted DBM complex in the capital femoral epiphysis. At twelve weeks, new bone along with new cartilage formation was observed in the capital femoral epiphysis. CONCLUSION: In conclusion, curettage and DBM complex graft is thought to be an effective treatment modality that promote regeneration of ischemic necrosis of capital femoral epiphysis.


Subject(s)
Bone Matrix , Cartilage , Curettage , Epiphyses , Head , Hip Joint , Legg-Calve-Perthes Disease , Ligation , Necrosis , Osteogenesis , Regeneration , Swine , Transplants
11.
Article in Korean | WPRIM | ID: wpr-139182

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the clinical and radiological outcomes of the S.E.R.I. (simple, effective, rapid, inexpensive) operation for the bunionette deformity. MATERIALS AND METHODS: Between March 2005 and February 2009, 22 patients (26 feet) who had been treated for the bunionette deformity with minimally invasive osteotomy were reviewed retrospectively. Clinically, Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, shoes selectivity, disappearance of callus and patient's satisfaction level by Coughlin scoring system were evaluated. Radiologically, the bunionette was classified as four types according to the Fallat classification. The 4-5th intermetatarsal angle (4-5th IMA), the 5th metatarsophalangeal angle (5th MPA) and the length of 5th metatarsal bone (5th MTL) were analyzed at preoperatively and at final follow up visit. RESULTS: VAS improved from 6.8+/-1.8 points to 2.2+/-1.8 points (p<0.05). AOFAS score improved from 54.0+/-14.2 points to 90.0+/-4.8 points (p<0.05). There was no change in shoes selectivity. 9 feet (34.6%) were satisfied with excellent results, 16 feet (61.5%) with good results and 1 foot (3.9%) with fair results. The average 4-5th IMA was corrected from 10.1+/-2.3degrees to 4.4+/-1.7degrees (p<0.05). The average 5th MPA was corrected from 11.5+/-8.6degrees to -0.1+/-4.1degrees (p<0.05). The average 5th MTL was changed from 66.1+/-4.3 millimeters to 64.1+/-4.4 millimeters (p=0.069). There was no malunion, nonunion or delayed union and other perioperative complications. CONCLUSION: S.E.R.I. operation is less invasive and easy technique. This procedure is recommendable for the treatment of the bunionette deformity.


Subject(s)
Animals , Ankle , Bony Callus , Bunion, Tailor's , Congenital Abnormalities , Follow-Up Studies , Foot , Humans , Metatarsal Bones , Osteotomy , Retrospective Studies , Shoes
12.
Article in Korean | WPRIM | ID: wpr-139179

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the clinical and radiological outcomes of the S.E.R.I. (simple, effective, rapid, inexpensive) operation for the bunionette deformity. MATERIALS AND METHODS: Between March 2005 and February 2009, 22 patients (26 feet) who had been treated for the bunionette deformity with minimally invasive osteotomy were reviewed retrospectively. Clinically, Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, shoes selectivity, disappearance of callus and patient's satisfaction level by Coughlin scoring system were evaluated. Radiologically, the bunionette was classified as four types according to the Fallat classification. The 4-5th intermetatarsal angle (4-5th IMA), the 5th metatarsophalangeal angle (5th MPA) and the length of 5th metatarsal bone (5th MTL) were analyzed at preoperatively and at final follow up visit. RESULTS: VAS improved from 6.8+/-1.8 points to 2.2+/-1.8 points (p<0.05). AOFAS score improved from 54.0+/-14.2 points to 90.0+/-4.8 points (p<0.05). There was no change in shoes selectivity. 9 feet (34.6%) were satisfied with excellent results, 16 feet (61.5%) with good results and 1 foot (3.9%) with fair results. The average 4-5th IMA was corrected from 10.1+/-2.3degrees to 4.4+/-1.7degrees (p<0.05). The average 5th MPA was corrected from 11.5+/-8.6degrees to -0.1+/-4.1degrees (p<0.05). The average 5th MTL was changed from 66.1+/-4.3 millimeters to 64.1+/-4.4 millimeters (p=0.069). There was no malunion, nonunion or delayed union and other perioperative complications. CONCLUSION: S.E.R.I. operation is less invasive and easy technique. This procedure is recommendable for the treatment of the bunionette deformity.


Subject(s)
Animals , Ankle , Bony Callus , Bunion, Tailor's , Congenital Abnormalities , Follow-Up Studies , Foot , Humans , Metatarsal Bones , Osteotomy , Retrospective Studies , Shoes
13.
Article in Korean | WPRIM | ID: wpr-724673

ABSTRACT

There are several advantages for groin flap, but its small and unpredictable vessels of pedicle have made it to lose its initial popularity. Although it would be ideal flap when it is focused on its useful advantages such as relative larger size, low donor site morbidity and possible bone graft, there have been few studies for prognostic factors for successful groin flap. Authors intended to determine prognostic factors which are relative with success of free groin flap. From January 1985 to December 2007, 107 patients who underwent groin flap for reconstruction of extremities were selected consecutively. Univariate and multivariate analysis were performed to determine prognostic factors which were related with success of groin flap. Eighty of 107 (74.8%) flaps survived. There was significant difference in success rate according to the recipient site. Nineteen of 20 cases (95%) survived in upper extremities, but 61 of 87 cases (70.1%) survived in lower extremities, which was statistically significant (p=0.022). Univariate analysis showed that mean diameter of donor veins was significantly larger in success group (p=0.021). Groin flap is recommended for reconstruction of upper extremities than lower extremities. It is thought to be critical that surgeons try to match vessel diameters between donor and recipient site.


Subject(s)
Extremities , Glycosaminoglycans , Groin , Humans , Lower Extremity , Multivariate Analysis , Tissue Donors , Transplants , Upper Extremity , Veins
14.
Neurointervention ; : 107-115, 2009.
Article in English | WPRIM | ID: wpr-730347

ABSTRACT

PURPOSE: To test hypothesis that pre-stenting measurement of reactivity index by using acetazolamide-challenged CT perfusion could identify patients at risk for hyperperfusion after carotid stenting. MATERIALS AND METHODS: For 24 regions of interest in 12 patients with symptomatic unilateral high-grade carotid stenosis, asymmetric indexes for cerebral blood volume, cerebral blood flow, and mean transit time and reactivity index were calculated from resting and acetazolamide-challenged CT perfusion before and 1 day after carotid stenting. We subsequently compared pre-stenting asymmetric indexes and reactivity index with percent increase of cerebral blood flow 1 day after carotid stenting. RESULTS: Percent increase of cerebral blood flow on the first post-stenting day was not significantly different between visually decreased and normal cerebrovascular reserve groups. There was no significant correlation between pre-stenting asymmetric indexs of resting CT perfusion parameters and percent increase of cerebral blood flow 1 day after carotid stenting. On the other hand, pre-stenting reduction of reactivity index showed fair correlation with 1 day cerebral blood flow increase. However, hyperperfusion or hyperperfusion syndrome was not observed in any patient with reduced reactivity index. CONCLUSION: Pre-stenting measurements of resting CT perfusion parameters and reactivity index could not predict hyperperfusion after carotid stenting. However, pre-stenting reduction of reactivity index seems to fairly correlate with immediate post-stenting cerebral blood flow increase. Further studies with larger population should be performed to validate this preliminary result.


Subject(s)
Blood Volume , Brain , Carotid Stenosis , Hand , Humans , Perfusion , Stents
15.
Article in English | WPRIM | ID: wpr-65670

ABSTRACT

Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare. To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported. We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.


Subject(s)
Humans , Male , Meningeal Neoplasms/complications , Meningioma/complications , Middle Aged , Middle Cerebral Artery/pathology , Neoplasm Invasiveness , Skull Neoplasms/complications , Sphenoid Bone , Subarachnoid Hemorrhage/etiology
16.
Neurointervention ; : 61-68, 2008.
Article in Korean | WPRIM | ID: wpr-730162

ABSTRACT

Intracranial vertebrobasilar artery (VBA) dissection can be classified into three major clinical types: subarachnoid hemorrhage, headache, and nonhemorrhagic ischemic symptoms. And it has been more frequently identified since the introduction of advanced diagnostic imaging modalites including MR angiography and multidetector CT angiography. Aggressive treatment has been considered due to their tendency for early rebleeding and a fatal natural course. We describe approproiate neurointerventional options, based on he patterns of angiographic features and location of dissection.


Subject(s)
Angiography , Arteries , Diagnostic Imaging , Embolization, Therapeutic , Headache , Subarachnoid Hemorrhage
17.
Article in Korean | WPRIM | ID: wpr-35200

ABSTRACT

PURPOSE: To evaluate the usefulness of MDCT angiography in the diagnosis of vertebrobasilar artery dissection. MATERIALS AND METHODS: Between July 2003 and December 2005, 39 patients who underwent MDCT angiography and digital subtraction angiography with a history of suspicious vertebrobasilar artery dissection were selected. A blind interpretation of images was made by two observers, retrospectively. A diagnosis of dissection in MDCT angiography was made according to the following criteria: presence of an intimal flap, aneurysmal dilatation, abrupt or tapered luminal narrowing, alternatively dilated and narrowed lumen. The sensitivity and specificity of MDCT angiography in depicting vertebrobasilar artery dissection were determined. RESULTS: 43 vertebrobasilar artery dissections were diagnosed by MDCT angiography in 39 patients. The interobserver agreement was good (kappa =0.92). A diagnosis was made by the presence of an intimal flap (n=16, 36%), abrupt or tapered luminal narrowing (n=16, 36%), aneurysmal dilatation (n=13, 30%), alternatively dilated and narrow lumen (n=14, 32%). The sensitivities and specificities of MDCT angiography were 91%, 88% as determined by the first radiologist, and were 89%, 87% as determined by a second radiologist, respectively. CONCLUSION: MDCT angiography is a useful method for the diagnosis of vertebrobasilar artery dissection.


Subject(s)
Aneurysm , Angiography , Angiography, Digital Subtraction , Arteries , Diagnosis , Dilatation , Humans , Phenobarbital , Retrospective Studies , Sensitivity and Specificity , Vertebral Artery
18.
Article in Korean | WPRIM | ID: wpr-12890

ABSTRACT

PURPOSE: The purpose of this study is to determine the left ventricular mass (LVM) and the left coronary artery dimension and to investigate the relationship between the two values in the normotensive group and hypertensive group with using 16-channel multidetector CT (MDCT). MATERIALS AND METHODS: Among the patients who underwent a CT coronary angiogram procedure using 16-channel MDCT at Ajou University Hospital from October 2004 to February 2005, 33 patients became the subjects of this study. These 33 patients showed normal findings without calcification or stenosis of the coronary arteries. The total volume of the left ventricular wall was calculated using work-in-progress cardiac CT reconstruction software. The LVM could then be directly calculated by multiplying the left ventricular muscle volume by the myocardial tissue density, which was assumed to be 1.05 g/cm3. The coronary diameter was measured by a fixed threshold method from the transverse reformation images obtained along the long-axis of each coronary artery. We calculated the cross-sectional area (CSA) of the coronary arteries from the equation of pi D2/4 (D=diameter). Regression analysis was performed for the relationship between LVM and the left coronary artery dimensions with using a linear least-squares method. Comparison between the normotensive group and the hypertensive group was done using the Student t test. RESULTS: The average LVM was 127.9+/-36.2 g (mean+/-standard deviation) and the average left ventricular mass index (LVMI) was 74.7+/-15.5 g in this study population. The average diameter of the coronary arteries was 4.38+/-0.69 mm for the left coronary artery. In all the subjects (n=33, r=0.67, p=0.000) and the normotensive group (n=21, r=0.68, p=0.000), the LVM was significantly correlated with the CSA of the left coronary artery, but not in the hypertensive group (n=12, r=0.57, p=0.062). In the hypertensive group, the CSA of the left coronary arteries per 100 g of muscle mass tended to decrease as the LVM increased. However, no statistical significance was demonstrated (r=-0.51, p=0.087). The end-diastolic left ventricular volume of the hypertensive group was smaller than that of the normotensive group (p=0.039). CONCLUSION: Using 16-channel MDCT, we could determine the LVM and coronary artery dimensions simultaneously in all the subjects. In all the subjects and the normotensive group, the LVM was significantly correlated with the CSA of the left coronary artery. However, the coronary artery dimensions did not increase commensurately with a concomitant increase of the LVM in the patients with hypertension.


Subject(s)
Constriction, Pathologic , Coronary Vessels , Heart , Humans , Hypertension , Myocardium
19.
Neurointervention ; : 54-57, 2006.
Article in Korean | WPRIM | ID: wpr-730286

ABSTRACT

We report a case of unruptured aneurysm associated with basilar fenestration treated with coil-assisted coil embolization. A 46-year-old man had suffered from intermittent, progressive occipital headache for 2 months. Magnetic resonance (MR) angiography showed a large aneurysm at the proximal basilar artery. Both three-dimensional CT angiography and angiography demonstrated a saccular, 20x15-mm aneurysm arising at the proximal end of associated fenestration at the basilar artery. The aneurysm was successfully occluded with stent-assisted coil embolization. The patient was discharged home after 1 week and received 75 mg clopidogrel once daily for 4 weeks and 100 mg aspirin once daily for life.


Subject(s)
Aneurysm , Angiography , Aspirin , Basilar Artery , Embolization, Therapeutic , Headache , Humans , Middle Aged , Stents
20.
Article in Korean | WPRIM | ID: wpr-102142

ABSTRACT

OBJECTIVE: The dissecting aneurysms of vertebral artery with various clinical manifestations have been increasingly reported with recent advent of diagnostic tools such as 3-Dimension computed tomography angiogram, magnetic resonance image and conventional angiogram. The authors analyzed the various treatment modalities according to their clinical presentations of vertebral artery dissecting aneurysms. METHODS: At the author's institution between March 2001 and February 2004, 28 patients were managed under diagnose of vertebral artery dissection. The medical record and neuroimaging studies of patients were reviewed retrospectively. RESULTS: Seven patients were presented with subarchnoid hemorrhage and 2 patients with mass effect. The other 12 patients were presented with ischemic stroke and 7 patients with headache or neck pain. 19 patients were treated with endovascular coils or stent. The other 8 patients were treated conservatively. and one patient was treated with operation. We had no endovascular treatment-related complications. Sixteen patients who underwent endovascular treatment survived with good recovery. but one patient died and 2 patients were in poor neurological status. Among patients with mass effect, one patient was treated with operation. and the other one patient with endovascular coils. We obtained optimal treatment results with improvement of myelopathy in both patients. CONCLUSION: The choice of the treatment of vertebral artery dissecting aneurysm of patients, clinical characteristics, and relation with posterior inferior cererebellar artery. The endovascular treatment using stent with/without coiling could be the treatment of choice if preservation of the vertebral artery is necessory.


Subject(s)
Aneurysm, Dissecting , Arteries , Headache , Hemorrhage , Humans , Medical Records , Neck Pain , Neuroimaging , Retrospective Studies , Spinal Cord Diseases , Stents , Stroke , Vertebral Artery Dissection , Vertebral Artery
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