摘要
BACKGROUND AND OBJECTIVES: Numbness on the hand occurs infrequently after a transradial cardiac catheterization (TRC). The symptom resembles that of neuropathy. We, therefore, investigated the prevalence, the predicting factors and the presence of neurological abnormalities of numbness, using a nerve conduction study (NCS). SUBJECTS AND METHODS: From April to December 2013, all patients who underwent a TRC were prospectively enrolled. From among these, the patients who experienced numbness on the ipsilateral hand were instructed to describe their symptoms using a visual analogue scale; subsequently, NCSs were performed on these patients. RESULTS: Of the total 479 patients in the study sample, numbness occurred in nine (1.8%) following the procedure. The NCS was performed for eight out of the nine patients, four (50%) of which had an abnormal NCS result at the superficial radial nerve. A larger sheath and history of myocardial infarction (p=0.14 and 0.08 respectively) tended towards the occurrence of numbness; however, only the use of size 7 French sheaths was an independent predictor for the occurrence of numbness (odds ratio: 5.50, 95% confidence interval: 1.06-28.58, p=0.042). The symptoms disappeared for all patients but one, within four months. CONCLUSION: A transient injury of the superficial radial nerve could be one reason for numbness after a TRC. A large sheath size was an independent predictor of numbness; therefore, large sized sheaths should be used with caution when performing a TRC.
Subject(s)
Humans , Cardiac Catheterization , Cardiac Catheters , Hand , Hypesthesia , Myocardial Infarction , Neural Conduction , Prevalence , Prospective Studies , Radial Nerve , Radial Neuropathy摘要
A 71-year-old woman who had suffered from pulmonary thromboembolism with deep vein thrombosis for 12 years presented the hospital with a huge thoracic aortic aneurysm. During thoracic endovascular therapy, she had a sudden coronary artery occlusion without having organized stenosis or plaque rupture even under the dual antiplatelet treatment and heparinization. She turned out to be having a protein S deficiency. A procedure related thrombotic adverse event in patient with protein S deficiency is very rare, so we report a case with literature review.
Subject(s)
Aged , Female , Humans , Aortic Aneurysm, Thoracic , Constriction, Pathologic , Coronary Thrombosis , Coronary Vessels , Endovascular Procedures , Heparin , Protein S Deficiency , Pulmonary Embolism , Rupture , Venous Thrombosis摘要
No abstract available.
Subject(s)
Aged , Humans , Male , Cardiovascular Agents/administration & dosage , Drug-Eluting Stents/adverse effects , Femoral Artery/diagnostic imaging , Foreign-Body Migration/diagnosis , Percutaneous Coronary Intervention/adverse effects , Prosthesis Design , Sirolimus/administration & dosage , Ultrasonography, Interventional摘要
Aortic coarctation is a correctable hypertensive disease. For safety reasons and due to the invasiveness of surgical techniques, percutaneous interventions have become drastically more popular in recent times. In elderly patients with aortic coarctation who are at risk of an aortic wall aneurysm and rupture, covered stents are preferred but in younger patients, bare metal stenting may be sufficient for long-term safety. Herein we present a 47-year-old typical aortic coarctation patient who was successfully treated with a bare metal stent.
Subject(s)
Adult , Aged , Humans , Aneurysm , Angioplasty , Aortic Coarctation , Rupture , Stents摘要
We present the case of aortoiliac stent restenosis which was caused by 13 years' of neointimal progression within and at the edge of the aortoiliac stent at the iliac bifurcation. A 74 year-old man presented with vertigo. We planned 4-vessel cerebral angiography through the right common femoral artery to evaluate his carotid artery but failed due to the catheter jam against the struts of the previously deployed aortoiliac stent. Retrograde sheath angiography through the right femoral artery indicated that the previously implanted stent seemed to have migrated in a downward direction and be embedded in the internal iliac artery. While comparing with the previous angiograms, we found that the implanted stent did not migrate downwardly but was separated from the external iliac artery by newly formed septum of neointimal hyperplasia. We successfully reopened the stenosis using the contralateral approach after widening the struts of the previously deployed T-stents.
Subject(s)
Angiography , Carotid Arteries , Catheters , Cerebral Angiography , Constriction, Pathologic , Femoral Artery , Hyperplasia , Iliac Artery , Peripheral Arterial Disease , Stents , Vertigo摘要
The incidence of blunt aortic injury is on the rise worldwise because of vehicular trauma. Historically, open repair was the only treatment of option. However, after developing of stent graft, endovascular repair has become more common and preferred treatment for aortic injury.
Subject(s)
Incidence , Stents , Transplants摘要
BACKGROUND AND OBJECTIVES: Percutaneous cardiopulmonary support (PCPS) has proven to be a valuable technique in high-risk coronary patients undergoing percutaneous coronary intervention (PCI). However, there have been few studies on PCI associated with PCPS in Korea. We summarized our experience with PCPS-supported PCI. SUBJECTS AND METHODS: We retrospectively reviewed 19 patients with PCPS-supported PCI between August 2005 and June 2009. PCPS was used as an elective procedure for 10 patients with at least two of the following conditions: left-ventricular ejection fraction <35%, target vessel(s) supplying more than 50% of the viable myocardium, high risk surgical patients, and patients who refused coronary bypass surgery. In the remaining 9 patients PCPS was used as an emergency procedure, to stabilize and even resuscitate patients with acute myocardial infarction and cardiogenic shock, in order to attempt urgent PCI. RESULTS: Among the 19 patients who were treated with PCPS-supported PCI, 11 (57.9%) survived and 8 (42.1%) patients did not. ST elevation myocardial infarction with cardiogenic shock was more prevalent in the non-survivors than in the survivors (75% vs. 27.3%, p=0.04). The elective PCPS-supported PCI was practiced more frequently in the survivors than in the non-survivors (72.7% vs. 25%, p=0.04). In the analysis of the event-free survival curve between elective and emergency procedures, there was a significant difference in the survival rate (p=0.025). Among the survivors there were more patients with multi-vessel disease, but a lower Thrombolysis in Myocardial Infarction grade in the culprit lesions was detected in the non-survivors, before PCI. Although we studied high-risk patients, there was no procedure-related mortality. CONCLUSION: Our experience suggests that PCPS may be helpful in high risk patients treated with PCI, especially in elective cases. More aggressive and larger scale studies of PCPS should follow.
Subject(s)
Humans , Disease-Free Survival , Emergencies , Korea , Myocardial Infarction , Myocardium , Percutaneous Coronary Intervention , Retrospective Studies , Shock, Cardiogenic , Survival Rate , Survivors摘要
Endovascular repair of inflammatory aortic aneurysms has been reported as an alternative to open surgical treatment. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We report a case of endovascular repair of an inflammatory aortic aneurysm in a patient with Behcet's disease using a carotid-carotid bypass graft to provide an adequate landing zone. A 45-yr-old man with a voice change was referred to our hospital with the diagnosis of saccular aneurysm of the distal aortic arch resulting from vasculitis. Computed tomography showed a thoracic aortic aneurysm with thrombosis. Right to left carotid-carotid bypass grafting was performed. After 8 days, the patient underwent an endovascular stent graft placement distal to the origin of the innominate artery. The patient was discharged with medication and without postoperative complications after 5 days. Hybrid endovascular treatment may be suitable a complementary modality for repairing inflammatory aortic aneurysms.
Subject(s)
Humans , Male , Middle Aged , Aortic Aneurysm, Thoracic/complications , Behcet Syndrome/complications , Blood Vessel Prosthesis Implantation/methods , Carotid Arteries/physiopathology , Coronary Artery Bypass , Endovascular Procedures , Stents , Thrombosis/complications , Tomography Scanners, X-Ray Computed , Vasculitis/complications摘要
OBJECTIVE: The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. MATERIALS AND METHODS: Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months) RESULTS: Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. CONCLUSION: The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Embolization, Therapeutic/methods , Enbucrilate/administration & dosage , Postoperative Complications/therapy , Punctures , Stents摘要
Coronary artery disease remains the leading cause of early death and graft loss in renal transplant patients. The aim of this study was to identify clinical and echocardiographic parameters independently associated with the angiographically-determined severity of coronary atherosclerosis in long-term kidney transplant patients. Fifty-two kidney transplant recipients who underwent elective coronary angiography were reviewed retrospectively. Angiographic severity was evaluated using the modified Gensini index (MGI). The mean age at coronary angiography was 52.5+/-7.9 yr with a mean prior transplant duration of 118.1+/-58.8 months. Pearson correlation analysis demonstrated a positive correlation of MGI with transplant duration before coronary angiography and chronic allograft nephropathy, whereas an inverse correlation was demonstrated with ejection fraction and statin use. On subsequent multivariate linear regression analysis, transplant duration before coronary angiography, statin use, and ejection fraction were independently associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. In summary, our study demonstrates that statin use, ejection fraction, and transplant duration before coronary angiography are independent parameters associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. Further investigation is required to reduce the atherosclerotic burden in kidney transplant patients.
Subject(s)
Adult , Female , Humans , Male , Comorbidity , Coronary Artery Disease/diagnosis , Incidence , Kidney Transplantation/statistics & numerical data , Korea/epidemiology , Renal Insufficiency/epidemiology , Risk Assessment , Risk Factors , Statistics as Topic摘要
A 67 years old male patient was admitted with back pain that had recurred from 6 months previously. Eleven years previously, he underwent stent grafting at the descending thoracic aorta for a chronic Stanford type B aortic dissection. The preoperative computed tomography showed aortic dissection from the origin of the left subclavian artery to the bifurcation of the abdominal aorta, and there was a type I endoleak at the proximal portion of the stent graft and aneurysmal dilatation of the descending aorta. A hybrid endovascular repair was successfully performed, and this involved debranching and rerouting the aortic arch vessels under extracorporeal cardiopulmonary bypass and then this was followed 13 days later by stenting in the ascending aorta, the aortic arch and the descending aorta. The postoperative computed tomography showed complete exclusion of the type I endoleak. After discharge, he has been followed up for 8 months without any problems.
Subject(s)
Humans , Male , Aneurysm , Aorta , Aorta, Abdominal , Aorta, Thoracic , Back Pain , Cardiopulmonary Bypass , Chimera , Dilatation , Endoleak , Stents , Subclavian Artery , Transplants摘要
A 64-year-old man complaining of pulsatile headache was admitted. Imaging studies revealed a near-total occlusion of the right proximal internal carotid artery (ICA) with slow antegrade flow into the distal ICA. Right cerebral flow was supplied by collateral flow through the posterior communicating and ophthalmic arteries. He was successfully treated by carotid artery stenting. No new neurological deficit or transient ischemic attack occurred after treatment.
Subject(s)
Humans , Middle Aged , Carotid Arteries , Carotid Artery Thrombosis , Carotid Artery, Internal , Headache , Ischemic Attack, Transient , Ophthalmic Artery , Stents摘要
Elective surgical repair has traditionally been considered to be the treatment of choice for the exclusion of isolated iliac artery aneurysms (IAAs). Recently, endovascular repair has evolved as an alternative to surgical repair, especially in patients at high surgical risk. However, in the absence of sufficient proximal necks, iliac artery aneurysms are not suitable for direct deployment of a tubular-shaped endograft. Here we report two cases of IAAs with short proximal necks that were excluded using an endovascular bifurcated stent-graft. The bifurcated stent-graft was successfully deployed with complete exclusion of the aneurysm. In neither case was there evidence of procedural failures. There were no signs of significant complications. We conclude that endovascular repair of IAAs with short proximal necks is feasible and efficient using an endovascular bifurcated stent-graft.
Subject(s)
Humans , Aneurysm , Angioplasty , Iliac Aneurysm , Iliac Artery , Neck , Stents摘要
A stent fracture combined with a coronary artery aneurysm is a rare event. As these events can lead to a harmful outcome, such as the development of myocardial ischemia by in-stent restenosis or thrombosis, repeated coronary intervention may be required. We report a case of a stent fracture combined with a coronary artery aneurysm. The fracture was thought to have developed by mechanical stress produced from a change of regional wall motion after an anteroseptal myocardial infarction. As detected by the use of intravascular ultrasound, neither in-stent restenosis nor a thrombus in the fractured stent was present. A cardiac magnetic resonance image showed that no viable myocardium in the anteroseptal wall was present. Therefore, the patient underwent medical treatment without intervention of the fractured stent.
Subject(s)
Humans , Aneurysm , Anterior Wall Myocardial Infarction , Coronary Vessels , Magnetic Resonance Spectroscopy , Myocardial Ischemia , Myocardium , Stents , Stress, Mechanical , Thrombosis摘要
PURPOSE: Renal artery stenosis (RAS) causes or deteriorates hypertension and/or renal insufficiency, and is known as a progressive disease. The aim of this study is to reveal the change of renal function after stenting for RAS. METHODS: We retrospectively analyzed 66 patients between 1999 and 2005 who had stenting for RAS. Renal function was assessed by modified MDRD equation. According to baseline glomerular filtration rate (GFR), patients were divided into subgroups with group A (n=37, GFR > or =60 mL/min/ 1.73m2) or group B (n=29, GFR <60 mL/min/1.73m2). Clinical parameters were compared between two groups. RESULTS: A total of 66 patients (male:female=37:29) were studied. The mean age was 61+/-12 years old and the mean follow-up duration was 54+/-27 months. Sixty-one (92.4%) patients had hypertension, 20 (30.3%) had diabetes, and 48 (73%) had unilateral RAS. Group B was older than group A (65+/-9 vs. 58+/-14 years old). The mean body mass index of group B was higher than that of group A. In group A, there was a decrease in the MDRD GFR (from 75+/-11 to 70+/-15 mL/min/1.73m2; p=0.038). In contrast, in group B there was no significant change in the MDRD GFR (from 48+/-9 to 48+/-15 mL/min/1.73m2). In group A and group B, renal function has been improved in 3% and 24%, and stabilized in 70% and 52%, respectively. CONCLUSION: Stenting for RAS has renal function preserving effect in patients with renal insufficiency. Therefore, stenting should be considered as a treatment modality in RAS patients even with deteriorated renal function.
Subject(s)
Humans , Body Mass Index , Constriction, Pathologic , Follow-Up Studies , Glomerular Filtration Rate , Hypertension , Renal Artery , Renal Artery Obstruction , Renal Insufficiency , Retrospective Studies , Stents摘要
Endovascular aneurysm repair (EVAR) was initially introduced as a less invasive alternative to conventional open repair. EVAR was subsequently adopted as a treatment option for abdominal aortic aneurysm. In Korea, open repair is more widely available than EVAR, although EVAR can be performed in several hospitals. Due to the rapidly aging population in Korea, there has been a shift from private healthcare to government-regulated universal coverage and EVAR may be a more feasible option for cardiovascular interventionalists in these days. The improvement of EVAR was rapidly attained by many pioneers for the last two decades. Although issues such as indications and durability of EVAR remain to be elucidated, its application can be extended further of milder invasiveness-related effects on comorbidities and less discomfort to patients. Aortic stent-grafting has been performed for various aortoiliac pathologies over the last 13 years at our cardiovascular center.1-3) This article presents a comprehensive review on EVAR by focusing on the clinical trials, indications, complications, and expertise in decision making for EVAR.
Subject(s)
Humans , Aging , Aneurysm , Aorta, Abdominal , Aortic Aneurysm , Aortic Aneurysm, Abdominal , Comorbidity , Decision Making , Delivery of Health Care , Korea , Pathology , Stents , Universal Health Insurance摘要
Coarctation of aorta is a rare vascular disorder which is one of causes of secondary hypertension. Since the early 1990s stenting in the coarctation of aorta has been introduced as an alternative treatment method, there were a few cases which were treated by stent implantation for the coarctation of the aorta in Korea. But the case which was treated using stent in congestive heart failure with pulmonary edema has never been reported. We report on successful management of a 64-year-old female patient, who presented with acute heart failure and pulmonary edema due to severe aortic coarctation. After endotracheal intubation, aortogram was performed, which revealed a severe narrowing in the distal thoracic aorta with a peak systolic pressure gradient of 100 mmHg across the lesion. Stent implantation was performed with 24x100 mm self-expandable Nitinol-S stent after predilation with 10x40 mm balloon. After stenting, patient's symptom and sign of congestive heart failure were remarkably improved and endotracheal intubation tube was able to be removed. And no significant adverse cardiac events observed during a nine-month clinical follow-up.
Subject(s)
Female , Humans , Middle Aged , Angioplasty , Aorta , Aorta, Thoracic , Aortic Coarctation , Blood Pressure , Follow-Up Studies , Heart Failure , Hypertension , Intubation, Intratracheal , Korea , Pulmonary Edema , Stents摘要
A 27-year-old male was admitted with a three week history of pain and gangrenous changes of his first to fourth right foot toes. Clinical, laboratory and angiographic findings were consistent with Buerger's disease. The patient was treated by subintimal balloon angioplasty of the right anterior tibial artery. The percutaneous subintimal angioplasty was successful, and the patient symptoms and the ankle brachial index was improved. The value of subintimal angioplasty in limb-threatening ischemia in Buerger's disease, has not been established but this case illustrates a role for subintimal angioplasty in acute ischemia.
Subject(s)
Adult , Humans , Male , Angioplasty , Angioplasty, Balloon , Ankle Brachial Index , Foot , Ischemia , Thromboangiitis Obliterans , Tibial Arteries , Toes摘要
BACKGROUND: Cardiovascular disease is the leading cause of death in postmenopausal women. The use of hormone replacement therapy (HRT) preventing for cardiovascular disease in postmenopausal women remains controversial. We investigated the effect of HRT on carotid intima-media thickness (IMT) according to the HRT duration in healthy postmenopausal women. METHODS: One hundred and twenty postmenopausal women (mean age: 55.4 +/- 3.3 years) were classified into never users, short-term, and long-term users according to the HRT duration. Carotid IMT was measured, and the clinical and biochemical cardiovascular risk factors were examined. RESULTS: The mean IMT was significantly thinner in the long-term users than that in the never users (0.62 +/- 0.11 vs. 0.71 +/- 0.14 mm, P < 0.01). Also, the maximal IMT was significantly thinner in the short-term and the long-term users. However, there is no significant difference in the mean and maximal IMTs between the estrogen alone and estrogen plus progestins used group. The period exposed to menopause was significantly shorter in the long-term users than that in the never users (1.8 +/- 2.3 vs. 4.3 +/- 3.3 years, P < 0.001). CONCLUSION: Our findings suggest that if HRT is initiated during early postmenopausal period before the onset of atherosclerosis, HRT may have a beneficial effect on the prevention of carotid atherosclerosis.