Research progress of transradial approach in neurointerventional diagnosis and treatment / 中华神经科杂志

Compared with the traditional transfemoral approach, the transradial approach (TRA) can be used as a new alternative approach in the diagnosis and treatment of neurointervention, and has more advantages in reducing access site complications, improving the comfort of patients, shortening the length of hospital stay, and reducing the overall medical costs, so it has attracted clinical attention. This article mainly reviews the application of TRA in the field of neurointerventional diagnosis and treatment, as well as its advantages, complications and other aspects, and puts forward its application prospects in the field of neurointerventional diagnosis and treatment, so as to provide reference for the development of this technology in the field of neurointerventional diagnosis and treatment and further research in this field.

Trans-radial cerebral angiography-safety, efficacy and patient comfort: review of literature

A diagnostic cerebral angiography is a vital tool in the planning and management of various cerebrovascular conditions. Newer angiographic modalities, such as digital subtraction angiography offers dynamic imaging of the cerebral blood flow and is the preferred diagnostic modality of choice when a subsequent intervention is contemplated. Traditionally, the transfemoral route at the groin was used as the site for vascular access. However, landmark randomised controlled trials in the field of interventional cardiology have demonstrated the safety, efficacy and patient comfort attained by employing a trans-radial access for angiography and interventions. This has spawned numerous studies which were directed explicitly towards cerebral angiography and neuro-intervention. We present this review of literature to consolidate the current practices and to encourage the neuro-interventionalists to shift to a radial first approach.

Clinical efficacy and prognostic quality of neurointervention combined with alteplase in the treatment of acute ischemic stroke / 国际生物医学工程杂志

Objective:To study the clinical efficacy and prognostic quality of neurointervention combined with alteplase in the treatment of acute ischemic stroke.Methods:Ninety-two patients with acute ischemic stroke admitted to the First People's Hospital of Bijie City from February 2019 to December 2020 were selected and divided into the control group and the observation group using the random number method, with 46 cases in each group. Patients in both groups received conventional treatment with intravenous thrombolytic therapy with alteplase, and on this basis, patients in the observation group received neurointerventional treatment. The overall efficiency, national institutes of health stroke scale (NIHSS) score, modified Thrombolysis in cerebral infarction classification (mTICI) score, modified rankin scale (mRS) score, complication rate, and prognostic indexes of patients in both groups were compared after the treatment.Results:The total treatment efficiency of patients in the observation group was 93.48%, which was significantly higher than that of 76.09% in the control group ( P<0.05). The NIHSS scores of both groups were significantly lower than those of the same period before treatment at 1 and 7 days and 1 and 3 months after the treatment (all P<0.05), and the NIHSS scores of the observation group were significantly lower than those of the control group at the same period ( P<0.01). The proportions of mTICI grades < grade 2 and mRS scores in the observation group were significantly lower than those in the control group after treatment(all P<0.05). The overall complication rate of patients in the observation group was significantly lower than that of the control group( P<0.05), and the re-infarction rate of patients in the observation group was significantly lower than that of the control group ( P<0.05). Conclusions:For acute ischemic stroke, neurointervention combined with alteplase is effective, can reduce the risk of complications, and improve the quality of the patient's prognosis, and therefore deserves to be promoted in clinical practice.

Monoplane 3D Overlay Roadmap versus Conventional Biplane 2D Roadmap Technique for Neurointervenional Procedures / 신경중재치료의학

PURPOSE: We investigated whether a 3D overlay roadmap using monoplane fluoroscopy offers advantages over a conventional 2D roadmap using biplane fluoroscopy during endovascular aneurysm treatment. MATERIALS AND METHODS: A retrospective chart review was conducted for 131 consecutive cerebral aneurysm embolizations by three neurointerventionalists at a single institution. Allowing for a transition period, the periods from January 2012 to August 2012 (Time Period 1) and February 2013 to July 2013 (Time Period 2) were analyzed for radiation exposure, contrast administration, fluoroscopy time, procedure time, angiographic results, and perioperative complications. Two neurointerventionalists (Group 1) used a conventional 2D roadmap for both Time Periods, and one neurointerventionalist (Group 2) transitioned from a 2D roadmap during Time Period 1 to a 3D overlay roadmap during Time Period 2. RESULTS: During Time Period 2, Group 2 demonstrated reduced fluoroscopy time (p<0.001), procedure time (P=0.023), total radiation dose (p=0.001), and fluoroscopy dose (P=0.017) relative to Group 1. During Time Period 2, there was no difference of immediate angiographic results and procedure complications between the two groups. Through the transition from Time Period 1 to Time Period 2, Group 2 demonstrated decreased fluoroscopy time (p<0.001), procedure time (p=0.022), and procedure complication rate (p=0.041) in Time Period 2 relative to Time Period 1. CONCLUSION: The monoplane 3D overlay roadmap technique reduced fluoroscopy dose and fluoroscopy time during neurointervention of cerebral aneurysms with similar angiographic occlusions and complications rate relative to biplane 2D roadmap, which implies possible compensation of limitations of monoplane fluoroscopy by 3D overlay technique.

Medical Problems during Participation of Medical Congress - A Long Trip to Val D'Isere from Korea / 신경중재치료의학

Since the 3rd WIN meeting in 1982 more than 500 participants join the meeting in Val D'Isere every year [1]. One of our authors has attended the meeting more than 10 times. He experienced many physical illnesses while travelling from South Korea to Val D'Isere in France, which is located in the Alps mountain near the border between France and Italy. In order to get there, it is necessary to take airplane, train, and/or bus with a heavy suitcase. During the trip which usually takes more than 15 hours, he experienced headache, gastrointestinal trouble, sleep disturbance and other additional physical illnesses. Therefore, we reviewed the itinerary to Val D'Isere and presented physical illnesses which occurred during a long trip for an academic activity by specialized professionals such as university hospital professors. In addition, we discussed the mechanism of such illnesses and offered possible solutions including medical treatment.

Outpatient Day-care Neuroangiography and Neurointervention of Unruptured Intracranial Aneurysms / 신경중재치료의학

PURPOSE: Day-care management of unruptured intracranial aneurysms can shorten hospital stay, reduce medical cost and improve outcome. We present the process, outcome and duration of hospital stay for the management of unruptured intracranial aneurysms via a neurointervention clinic in a single center during the past four years. MATERIALS AND METHODS: We analyzed 403 patients who were referred to Neurointervention Clinic at Asan Medical Center for aneurysm evaluation between January 1, 2011 and December 31, 2014. There were 141 (41%) diagnostic catheter angiographies, 202 (59%) neurointerventional procedures and 2 (0.6%) neurointerventional procedures followed by operation. We analyzed the process, outcome of angiography or neurointervention, and duration of hospital stay. RESULTS: There was no aneurysm in 58 patients who were reported as having an aneurysm in MRA or CTA (14 %). Among 345 patients with aneurysm, there were 283 patients with a single aneurysm (82%) and 62 patients with multiple aneurysms (n=62, 18%). Aneurysm coiling was performed in 202 patients (59%), surgical clipping in 14 patients (4%), coiling followed by clipping in 2 patients (0.6%) and no intervention was required in 127 patients (37%). The hospital stay for diagnostic angiography was less than 6 hours and the mean duration of hospital stay was 2.1 days for neurointervention. There were 4 procedure-related adverse events (2%) including 3 minor and 1 major ischemic strokes. CONCLUSION: Our study revealed that day-care management of unruptured intracranial aneurysms could be performed without an additional risk. It could enable rapid patient flow, shorten hospital stay and thus reduce hospital costs.

Staged target teaching method of neural interventional therapy for ischemic cerebrovascular disease / 中国脑血管病杂志

Objective To strengthen the training effect of the neuro-interventional surgeons using staged target teaching method. Methods A total of 39 neurosurgeons from all over the country were trained at the Department of Interventional Radiology,Xuanwu Hospital,Capital Medical University from March 2012 to March 2013. In the one-year training period,the training was divided into 4 stages (each stage for 3 months). All the learning contents were phased to focus on teaching and set the target at each stage,which had a clear purpose. Questionnaires were sent to the refresher doctors at 6 months and 12 months after they returned to their original work in order to obtain the conditions about their independent work after training. Results All the 39 neurosurgeons achieved their desired goal from theory to practical operation. They mastered the holistic treatment principles of ischemic cerebrovascular disease and were familiar with and mastered the whole brain DSA and stenting techniques. At the fourth stage,as an operator, everyone had finished at least 5 extracranial artery stentings. The recovered questionnaires after the end of training showed that 95. 8%(23/24)neurosurgeons were able to perform whole brain DSA independently and held≥5 surgeries monthly;87. 5%(21/24)neurosurgeons could complete stenting independently (1 patient/month). Conclusion The staged target teaching method is a practical and effective teaching means for special technical training of neurointervention.

Anesthetic Consideration for Neurointerventional Procedures / 신경중재치료의학

Interventional neuroradiology (INR) has been a rapidly expanding and advancing clinical area during the past few decades. As the complexity and diversity of INR procedures increases, the demand for anesthesia also increases. Anesthesia for interventional neuroradiology is a challenge for the anesthesiologist due to the unfamiliar working environment which the anesthesiologist must consider, as well as the unique neuro-interventional components. This review provides an overview of the anesthetic options and specific consideration of the anesthesia requirements for each procedure. We also introduce the anesthetic management for interventional neuroradiology performed in our medical institution.

Current Status of Neurointerventional Activities in Korea / 신경중재치료의학

Neurointervention which deals with neurovascular disease in brain, head-and-neck and spines are one of the rapidly evolving medical fields. Several indices representing neurointerventional activities are still increasing year-by-year in Korea. We review current trend in major neurovascular diseases requiring usage of specific medical devices and some issues related to administrative process of the government approval.

Recent Update of Guidelines for Neurointerventional Procedures / 신경중재치료의학

Treatment guidelines of the neurointerventional procedures are continuously updated. However, these guidelines differ between countries and even medical societies within the same country because of the differing interests and patient groups. The differences between guidelines are confusing to many neurointerventionalists. Recently "Clinical Research Center for Stroke" in Korea updated "Clinical Practice Guidelines for Stroke" for the patients in Korea. So we introduce those guidelines and compare several recent guidelines of international medical societies for neurointerventionalists.

Outpatient (Same-day care) Neuroangiography and Neurointervention / 신경중재치료의학

PURPOSE: There have been few reports regarding same-day discharge following uncomplicated procedures such as cerebral angiography and neurointervention. We present same-day experience with cerebral angiography and neurointervention during the past three years. MATERIALS AND METHODS: Four hundred and fifty-three patients underwent cerebral angiography or neurointervention at Asan Medical Center between January 2009 and December 2011. Of these patients, 249 (55%) underwent diagnostic catheter cerebral angiography and 204 patients (45%) underwent neurointerventional procedures as same-day procedures. We analyzed any complications, the modified patient-care process, the yearly trend in patient increases, disease categories, and the additional duration of admission for these procedures. RESULTS: The number of overall patients increased by an average of 51% annually. The disease categories included aneurysm (51%), atherosclerosis (11%) and arteriovenous malformation (10%), etc. for which the patient underwent angiography, and aneurysm (42%), venous malformation (28%), and arteriovenous malformation (17%), etc. for which patients underwent neurointervention. Same-day care patients were admitted to the intermediary care unit in the angiosuite. Neurointervention patients were sent to the neurology intensive unit after the procedure. The same-day care patients stayed in angiosuite for six hours following the transfemoral procedure. The mean admission duration for neurointervention was 2.4 days. There were no reported complications for the same-day care procedures. CONCLUSION: Our study revealed an increasing tendency toward same-day care for patients who require angiography and neurointervention. Further studies will be required to better define the cost-minimization effects of outpatient practice as well as the patient perception of this fast-tracking method. We propose that outpatient angiography and neurointervention will undoubtedly continue to increase over the next decade.

Significance of Clopidogrel Resistance Related to the Stent-Assisted Angioplasty in Patients with Atherosclerotic Cerebrovascular Disease

OBJECTIVE: To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease. METHODS: Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59+/-7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance. RESULTS: Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab. CONCLUSION: There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance. Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion.

Anti-Platelet Drug Resistance in the Prediction of Thromboembolic Complications after Neurointervention

OBJECTIVE: The aim of this study was to analyze the correlation between thromboembolic complications and antiplatelet drugs before and after neurointervention. METHODS: Blood samples and radiographic data of patients who received a neurointervention (coil embolization, stent placement or both) were collected prospectively. Rapid platelet function assay-aspirin (RPFA-ASA) was used to calculate aspirin resistance in aspirin reaction units (ARU). For clopidogrel resistance, a P2Y12 assay was used to analyze the percentage of platelet inhibition. ARU > 550 and platelet inhibition < 40% were defined as aspirin and clopidogrel resistance, respectively. RESULTS: Both aspirin and clopidogrel oral pills were administered in fifty-three patients before and after neurointerventional procedures. The mean resistance values of all patients were 484 ARU and < 39%. Ten (17.0%) of 53 patients showed resistance to aspirin with an average of 597 ARU, and 33 (62.3%) of 53 patients showed resistance to clopidogrel with an average of < 26%. Ten patients demonstrated resistance to both drugs, 5 of which suffered a thromboembolic complication after neurointervention (mean values : 640 ARU and platelet inhibition < 23%). Diabetic patients and patients with hypercholesterolemia displayed mean aspirin resistances of 513.7 and 501.8 ARU, and mean clopidogrel resistances of < 33.8% and < 40.7%, respectively. CONCLUSION: Identifying individuals with poor platelet inhibition using standard regimens is of great clinical importance and may help prevent cerebral ischemic events in the future. Neurointerventional research should focus on ideal doses, timing, choices, safety, and reliable measurements of antiplatelet drug therapy, as well as confirming the clinical relevance of aggregometry in cerebrovascular patients.

The Present Status of Neurointerventional Angiographic Systems and Workers in Korea / 신경중재치료의학

PURPOSE: The purpose of this study was to evaluate the present status of angiographic system for neurointervention and associated workers in Korea. This study would be used to preliminary data of the quality control of angiographic imaging for Korean Society of Interventional Neuroradiology. MATERIALS AND METHODS: This survey was conducted on the hospitals those have requested the cost of cerebral angiography to the national medical insurance in 2008. One hundred two hospitals were included in this study, and 82 hospitals responded to the survey. The survey was composed with questionnaires about present status of angiographic system for neurointervention and associated workers. RESULTS: Thirty five hospitals (42.7%) hospitals had an exclusive neurointerventional angiographic unit. Over a half of hospitals (60.2%) used angiographic systems those had been produced within 5years. Most of the angiographic systems (91.5%) had quality control regularly. Neurointerventionists had various subspecialties. CONCLUSION: This study presented the knowledge of present status of neurointerventional angiographic system and the working status of associated workers in Korea. This study would be applied to preliminary data of the quality accreditation program of angiographic system in Korea.

Vein of Galen Malformation in a Neonate: Case Report

A vein of Galen malformation(VGM) is a rare vascular malformation, often resulting in high morbidity or mortality. In the newborn, cardiac failure is the most common presenting, sign and the outcome is particularly poor. As the technique of neurointervention develops, embolizaton is known to be the choice of treatment reducing the mortality rate tremendously. The authors report a case of VGM, diagnosed in uterus and successfully managed by neuro-interventive treatment.

The Present and Future of Cerebrovascular Surgery

It is not an easy task to imagine what will happen to cerebrovascular surgery in the twenty-first century, considering the tremendous developments that have occurred during the past decades. This review paper is attempted to address the present and future of cerebrovascular surgery on the basis of author's experience of cerebrovascular diseases during the past 30 years. Cerebrovascular surgery has been recognized as a subspecialty of neurosurgery that requires utmost technical challenge and precision in all of medicine. Cerebrovascular surgery has achieved much that we can proud of. However, as forward-thinking cerebrovascular surgeons, our concern isn't with past glories. They would tackle questions of natural history, scientific assessment of therapy, outcomes sciences, and molecular basis of cerebrovascular disease. They would remain at the forefront of research in stroke and brain protection, and would succeed at the integration of endovascular, radiosurgical, and pharmacological tools into a truly multidisciplinary armamentarium.

More are awaiting for craniofacial intervention / 介入放射学杂志

The scale of craniofacial intervention lies between the fields of neuro-intervention and peripheral intervention for the main purpose to investigate,diagnose and treat the disease entities originating from or supplied by the external carotid arterial system. Patients are usually refered to the oral and maxillofacial surgery,plastic surgery and otolaryngeal surgery. Craniofacial intervention includes mainly the diagnosis and treatment with adjuvant embolization of high-flow vascular diseases,intra-arterial chemotherapy of malignant tumors,embolization of epistaxis,etc. At present,there is no consensus with regard to the diagnosis and treatment of some craniofacial diseases,therefore further investigation and discussion are needed.(J Intervent Radiol,2006,15: 321-322)

Manangement Outcome of 372 Patients with Unruptured Intracranial Aneurysms / 대한뇌혈관학회지

OBJECTIVE: The purpose of this study was to provide management strategy and to improve management outcome of patients with unruptured intracranial aneurysms (UIA). PATIENTS AND METHODS: The authors reviewed the database as sources for identifying and analyzing patients, and analyzed the management outcome of patients with UIA. From June 1979 to June 1999, among total of 1,801 patients treated for intracranial aneurysms, 372 patients with 437 unruptured aneurysms were treated by surgery (335 patients) or neurointervention (37 patients). One hundred and forty - three patients with 158 UIA had no history of SAH from a different aneurysm (group 1), and 229 patients with 279 UIA had a ruptured aneurysm that have been repaired simultaneously or before treatment of UIA (group 2). We reviewed the rate of favorable (good, fair) and unfavorable (poor or dead) outcome one year after the treatment. RESULTS: The rate of favorable and unfavorable outcome in group 1 was 96.5% and 3.5% respectively. In Group 2, the rate was 93.5% and 6.5%. However, the most of the unfavorable outcome in group 2 came from treatment of the ruptured aneurysm, or SAH. The only significant factor contributed to unfavorable outcome in group 1 was size of UIA. Those of group 2 were age, Fisher grade, Hunt - Hess grade, and aneurysm number. Complications attributable to surgical or endovascular treatment of UIA that occurred in 38 of 372 patients (10.2%) were cerebral infarction (17), intracerebral hemorrhage (10), epidural hematoma (4), cranial nerve injury (3), infection (2), venous infarction (1), and subarachnoid hemorrhage (1). CONCLUSION: Rupture of an intracranial aneurysm is a devastating event. The safe size below which rupture is unlikely is unclear. There appears to be increased risk from unruptured aneurysms discovered in SAH patients. All unruptured aneurysms in healthy patients as well as in patients with history of SAH should be repaired.