Although the carotid endarterectomy presently represents the standard therapeutic approach for most patients with significant carotid artery stenosis, a percutaneous transluminal angioplasty (PTA) with stenting has become an alternative method for treating patients with co-mobid conditions, particulary coronary artery disease. A PTA with stenting has the potential for being safer, less traumatic, more cost-effective, and useful in patients at high surgical risk. As well, they are not limited to the cervical carotid artery. But it is reported that carotid angioplasty by femoral approach is difficult to do in 1 - 2% of patients with carotid stenosis due to abnormal origin of carotid artery or occlusion of femoral arteries. We succeeded in PTA with stenting of tight stenosis of right internal carotid artery through the transseptal approach in case of a sharply angled right brachiocephalic artery take-off from the aorta. The transseptal approach can be used for PTA with stenting in case of problems with femoral approach.
Angioplasty ; Aorta ; Arteries ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Disease ; Endarterectomy, Carotid ; Femoral Artery ; Humans ; Stents*

Endovascular therapy, proposed as an alternative to surgery, is considered a therapeutic innovation because of its low degree of invasiveness, allowing for the treatment of high-risk surgical patients and outcomes of limited complications and mortality. The combination of endovascular exclusion with cerebral branch revascularization for the treatment of thoracic aortic aneurysms involving arch has also been attempted. With improved capability to recognize proper anatomy and select clinical candidates, endovascular therapy may offer a strategy to optimize management and improve prognosis for thoracic aortic aneurysm patients.
Aortic Aneurysm, Thoracic* ; Humans ; Mortality ; Prognosis

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Drug-Eluting Stents*

Critical limb ischemia (CLI) is the most severe peripheral artery disease and caused by thrombus formation in blood vessel. The current strategies for treating CLI does not protect limb amputation and reduction in the risk of mortality. Recently, human bone marrow derived mesenchymal stem cells (BD-MSC) were reported to have a paracrine effects on angiogenesis in several ischemic diseases. So, we validate to determine whether BD-MSC protect against ferric chloride treated CLI and induce angiogenesis. To characterized human bone marrow derived stem cell, BD-MSC differentiated to osteocytes and adipocytes and validated stemness using flow cytometry. Endothelial cell induced angiogenesis followed by mesenchymal stem cell cultured medium treatment in HUVEC in vitro. We also mimicked CLI patients condition using FeCl₃ treated CLI mouse and injected one hundred thousand of BD-MSC along the femoral artery to leg muscle. We validated stem cell survival, blood vessel formation, leg muscle condition and fibrosis compared by saline injected mice 28 days later. In this study, BD-MSC cultured medium treatment increased migration and tube formation of HUVEC and BD-MSC injection had an effective blood vessel formation in FeCl₃ treated CLI. As well as blood vessel formation, limb salvage rate also improved and fibrosis area statistically decreased in BD-MSC injected mice. In conclusion, bone marrow derived mesenchymal stem cell improved not only blood vessel formation but also reduction of fibrosis in FeCl₃ treated CLI mice and finally protected limb amputation.
Adipocytes ; Amputation ; Animals ; Blood Vessels ; Bone Marrow ; Endothelial Cells ; Extremities* ; Femoral Artery ; Fibrosis ; Flow Cytometry ; Humans ; In Vitro Techniques ; Ischemia* ; Leg ; Limb Salvage ; Mesenchymal Stromal Cells ; Mice ; Mortality ; Osteocytes ; Peripheral Arterial Disease ; Stem Cells ; Thrombosis

No abstract available.
Carcinoma, Hepatocellular* ; Heart Atria*

Renal artery aneurysm (RAA) is a rare disease, and the precise incidence has not been very well known. It appears that with the increasing use of diagnostic ultrasound, computed tomography and arteriography, RAA are being identified more frequently than in the past. Rupture of RAA is associated with 10% mortality and the chance of nephrectomy is very high. Although, most of renal artery aneurysms are treated by endovascular technique, surgery is often necessary for aneurysms associated with bifurcation area or large braches. Here, we report a case of saccular renal artery aneurysm which was managed by open surgery.
Aneurysm ; Angiography ; Endovascular Procedures ; Incidence ; Nephrectomy ; Rare Diseases ; Renal Artery ; Rupture

BACKGROUND AND OBJECTIVES: The clinical outcome of patient with an acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), with or without achievement of target low density lipoprotein-cholesterol (LDL-C), has little known information. This study investigated if target LDL-C level (below 70 mg/dL) achievements in patients with AMI showed better clinical outcomes or not. SUBJECTS AND METHODS: Between May 2008 and September 2012, this study enrolled 13473 AMI patients in a large-scale, prospective, multicenter Korean Myocardial Infarction (KorMI) registry. 12720 patients survived and 6746 patients completed a 1-year clinical follow up. Among them 3315 patients received serial lipid profile follow-ups. Propensity score matching was applied to adjust for differences in clinical baseline and angiographic characteristics, producing a total of 1292 patients (646 target LDL-C achievers vs. 646 non-achievers). The primary end point was the composite of a 1-year major adverse cardiac event (MACE) including cardiac death, recurrent myocardial infarction (MI), target lesion revascularization (TLR) and coronary artery bypass grafting. RESULTS: After propensity score matching, baseline clinical and angiographic characteristics were similar between the two groups. Clinical outcomes of the propensity score matched patients who showed no significant differences in cardiac death (0.5% vs. 0.5%, p=1.000), recurrent MI (1.1% vs. 0.8%, p=0.562), TLR (5.0% vs. 4.5%, p=0.649), MACEs (6.5% vs. 5.9%, p=0.644) and stent thrombosis (2.5% vs. 1.9%, p=0.560). CONCLUSION: In this propensity-matched comparison, AMI patients undergoing PCI with a target LDL-C (below 70 mg/dL) achievement did not show better clinical outcomes.
Coronary Artery Bypass ; Death ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Propensity Score ; Prospective Studies ; Stents ; Thrombosis ; Treatment Outcome

BACKGROUND AND OBJECTIVES: The differential diagnosis of a regular tachycardia, with a wide QRS complex(> or =20 msec) n the 12-lead electrocardiogram(CG), remains an important challenge. Despite the information available on electrocardiography in patients with ventricular tachycardia(T) nd supraventricular ventricular tachycardia, with aberrant conduction or pre-existed bundle branch block(ide-QRS SVT); the data from Korean is limited. The purpose of this study was to report on the differential diagnostic criteria.SUBJECTS AND METHODS: The clinical and electrocardiographic characteristics of 150 patients(5.8%) ith VT, and 78(4.2%) ith wide-QRS SVT, were evaluated. RESULTS: n atrioventricular(V) issociation was found in 44.7%(7/150) f the VTs, which is very useful in differential diagnosis. In the RBBB patterns, a monophasic R, or a biphasic, wave(R, RS), in the V1 lead, were present in 49.0 and 40.6% of VTs, respectively, and an R/S ratio of less than 1, in the V6 lead, was present in 89.6% of VTs. In the LBBB patterns, the duration of the R wave(gt; or =0 msec), the interval from the Q wave to the nadir of the S wave(> or =0 msec) nd the notching of the S wave, in the V1 lead, were present in 61.1, 87.0 and 31.3% of VTs, respectively. When an algorithm, using the AV dissociation and morphological criteria for a VT in the V1 and V6 leads, was tested for differentiation, the sensitivity and specificity were 96.7 and 93.6%, respectively. CONCLUSION: A more accurate, correct, diagnosis of wide-QRS tachycardia can be made by using a stepwise approaching method consisting of AV dissociation and morphological criteria for VT in the V1 and V6 leads.
Diagnosis ; Diagnosis, Differential* ; Electrocardiography* ; Humans ; Sensitivity and Specificity ; Tachycardia* ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

Cyclooxygenase-2 (COX-2)-mediated prostaglandin E₂ (PGE₂) plays a key role in development and progression of inflammatory responses and Porphyromonas gingivalis is a common endodontic pathogen. In this study, we investigated induction of COX-2 and PGE₂ by P. gingivalis in human dental pulp cells (HDPCs). P. gingivalis increased expression of COX-2, but not that of COX-1. Increased levels of PGE₂ were released from P. gingivalis-infected HDPCs and this PGE₂ increase was blocked by celecoxib, a selective COX-2 inhibitor. P. gingivalis activated all three types of mitogen-activated protein kinases (MAPKs). P. gingivalis-induced activation of nuclear factor-κB (NF-κB) was demonstrated by the results of phosphorylation of NF-κ B p65 and degradation of inhibitor of κB-α (IκB-α). Pharmacological inhibition of each of the three types of MAPKs and NF-κB substantially attenuated P. gingivalis induced PGE2 production. These results suggest that P. gingivalis should promote endodontic inflammation by stimulating dental pulp cells to produce PGE₂.
Celecoxib ; Cyclooxygenase 2 ; Dental Pulp* ; Dinoprostone ; Humans* ; Mitogen-Activated Protein Kinases ; Phosphorylation ; Porphyromonas gingivalis* ; Porphyromonas* ; Pulpitis