Development of Cloud-Based Telemedicine Platform for Acute Intracerebral Hemorrhage in Gangwon-do : Concept and Protocol

We aimed to develop a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local hospitals in rural and underserved areas in Gangwon-do using artificial intelligence and non-face-to-face collaboration treatment technology. This is a prospective and multi-center development project in which neurosurgeons from four university hospitals in Gangwondo will participate. Information technology experts will verify and improve the performance of the cloud-based telemedicine collaboration platform while treating ICH patients in the actual medical field. Problems identified will be resolved, and the function, performance, security, and safety of the telemedicine platform will be checked through an accredited certification authority. The project will be carried out over 4 years and consists of two phases. The first phase will be from April 2022 to December 2023, and the second phase will be from April 2024 to December 2025. The platform will be developed by dividing the work of the neurosurgeons and information technology experts by setting the order of items through mutual feedback. This article provides information on a project to develop a cloud-based telemedicine platform for acute ICH patients in Gangwon-do.

A Ruptured lenticulostriate artery aneurysm in moyamoya disease treated with Onyx embolization

Lenticulostriate artery (LSA) aneurysms are uncommon. Here, we report one case of ruptured LSA aneurysm which is related to Moyamoya disease (MMD). Surgical treatment of this aneurysm is challenging because of its deep location and complex neural structures around the LSA. We report one case treated with endovascular Onyx embolization, successfully and review LSA aneurysm associated with MMD.

A tiny bleb at Junctional Dilatation of the Posterior Communicating Artery as a Predisposing Factor for Development of a De Novo Aneurysm / 신경중재치료의학

Formation of de novo aneurysm from a junctional dilatation at the origin site of the posterior communicating artery (PcomA) has been rarely reported. In this case report, three females in sixth decades of age developed a de novo aneurysm from the junctional dilatation of the PComA with a tiny bleb-like lesion over 5 years after initial presentation.

Hemodynamic Characteristics Regarding Recanalization of Completely Coiled Aneurysms: Computational Fluid Dynamic Analysis Using Virtual Models Comparison / 신경중재치료의학

PURPOSE: Hemodynamic factors are considered to play an important role in initiation and progression of the recurrence after endosaccular coiling of the intracranial aneurysms. We made paired virtual models of completely coiled aneurysms which were subsequently recanalized and compared to identify hemodynamic characteristics related to the recurred aneurysmal sac. MATERIALS AND METHODS: We created paired virtual models of computational fluid dynamics (CFD) in five aneurysms which were initially regarded as having achieved complete occlusion and then recurred during follow-up. Paired virtual models consisted of the CFD model of 3D rotational angiography obtained in the recurred aneurysm and the control model of the initial, parent artery after artificial removal of the coiled and recanalized aneurysm. Using the CFD analysis of the virtual model, we analyzed the hemodynamic characteristics on the neck of each aneurysm before and after its recurrence. RESULTS: High wall shear stress (WSS) was identified at the cross-sectionally identified aneurysm neck at which recurrence developed in all cases. A small vortex formation with relatively low velocity in front of the neck was also identified in four cases. The aneurysm recurrence locations corresponded to the location of high WSS and/or small vortex formation. CONCLUSION: Recanalized aneurysms revealed increased WSS and small vortex formation at the cross-sectional neck of the aneurysm. This observation may partially explain the hemodynamic causes of future recanalization after coil embolization.

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.