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.
Aneurysm ; Humans ; Korea ; Societies, Medical

Carotid artery angioplasty with stenting (CAS) is being performed in many hospitals in Korea. Most of the guidelines which are being used are similar, but the practical aspects such as techniques are different between hospitals. For example, usage of various protective devices, the oral antiplatelet regimen prior to procedure and placing of temporary pacemaker to prevent bradycardia are different between hospitals. In this article, we summarize and propose the guidelines for CAS which is currently being accepted in Korea. These guidelines may be helpful in providing protocol to neurointerventionalist who perform CAS and to standardize the process including reporting of CAS in the future comparative trials in Korea.
Angioplasty ; Bradycardia ; Carotid Arteries ; Korea ; Protective Devices ; Stents*

PURPOSE: The International Subarachnoid Aneurysm Trial (ISAT) revealed that in ruptured intracranial aneurysms (RA), endovascular coiling (EC) yields better clinical outcomes than neurosurgical clipping (NC) at 1 year. In unruptured aneurysms (UIA), EC is being increasingly used as an alternative to NC due to patients' preference. There is a lot of difference in treatment cost (EC vs. NC) between countries. There is one recently published study dealing with the comparative cost analysis only in UIAs in South Korea. But it is a hospital-based study. So, the authors performed a nation-wide cost effective comparison in our country. MATERIALS AND METHODS: This study was a retrospective analysis of healthcare big data open systems in Health Insurance Review & Assessment Service (HIRA). Hospital cost data of the recent 5 years (from January 2010 to December 2014) were analyzed according to patients' age and sex and the presence of subarachnoid hemorrhage. RESULTS: When comparing the total hospital costs for NC of a UIA (n=13,756) and EC of a UIA (n=17,666), NC [mean±standard deviation (SD): ￦7,987,179±3,855,029] resulted in significantly lower total hospital costs than EC [￦10,201,645±5,001,626, p<0.0001], although a shorter hospital stay with EC of a UIA [8.6 ±7.4 days] vs. NC [15.0 ±8.3 days, p<0.0001]. When comparing the total hospital costs for NC of a RA (n=7,293) and EC of a RA (n=6,954), NC [￦13,914,993±6,247,914] resulted in significantly lower total hospital costs than EC [￦16,702,446±7,841,141, p<0.0001], although shorter hospital stays for EC of a RA [19.8 ±11.4] vs. NC [23.0 ±10.3, p<0.0001]. CONCLUSION: The total hospital costs for the NC of both UIAs and RAs were found to be lower than those for EC in South Korea.
Aneurysm ; Cost-Benefit Analysis* ; Costs and Cost Analysis ; Delivery of Health Care ; Health Care Costs ; Hospital Costs ; Insurance ; Insurance, Health ; Intracranial Aneurysm* ; Korea ; Length of Stay ; Republic of Korea* ; Retrospective Studies ; Subarachnoid Hemorrhage

Purpose: To evaluate the safety and efficacy of stent-assisted coil embolization (SAC) in acutely ruptured cerebral aneurysms without severe symptoms, and thus, the usefulness of the stent itself in patients with subarachnoid hemorrhages. Materials and Methods: From January 2017 to June 2019, 118 patients were treated with coil embolization for acutely ruptured cerebral aneurysms without severe symptoms (Hunt & Hess grade ≤ 3). The periprocedural complications, six-month modified Rankin scores (mRS), and six-month radiologic outcomes were compared between 56 patients with SAC and 62 patients without SAC (non-SAC). Results: The rate of good clinical outcomes (mRS ≤ 2), as well as the rate of hemorrhagic and ischemic complications, showed no significant difference between the SAC and non-SAC groups.Moreover, compared to the non-SAC group, the SAC group showed a lower recanalization rate on the six-month follow-up angiogram (20% vs. 39.3%, p = 0.001). Conclusion Although stent use was not significantly associated with clinical outcomes in coil embolization of ruptured cerebral aneurysms with non-severe symptoms (Hunt & Hess grade ≤ 3), it significantly decreased the rate of recanalization on follow-up cerebral angiograms.

PURPOSE: To describe the US findings of corpus luteum cyst rupture in order to elucidate the associated clinical features. MATERIALS AND METHODS: Twenty patients with proven corpus luteum cyst rupture were included in this study. The US findings of these patients were retrospectively analyzed in terms of the presence of designable cyst, size of the cyst, thickness and blood flow of the cyst wall, extension and echogenicity of peritoneal fluid, and involved site (right or left ovary). We also surveyed the clinical features such as the onset period according to the menstrual cycle, and the presence of suspectable cause. RESULTS: Fourteen of the 20 patients revealed designable cysts (mean diameter of 2.6 cm) with thick walled cysts (mean thickness, 4.6 mm, 2.4 -6.8 mm) and increased blood flow. Six patients didn 't reveal any cyst but only hematoma in adnexa. All patients had hemoperitoneum in the pelvic cavity, and the hemoperitoneum was extended to Morrison's pouch in 8 patients and to the subphrenic space in 6. The cysts occurred in the right adnexa in 15 patients and in the left in 5. Mean interval from the last menstrual period (LMP) was 26 days (13-44 days) and 6 of the 8 patients for whom it had been possible to obtain detailed history taking had had coitus just before the occurrence of symptom. CONCLUSION: When women who are hospitalized for acute abdomen and who are in luteal phase reveal US findings of hematoma or thick-walled cyst in adnexa and hemoperitoneum, a corpus luteum cyst rupture is highly suspected. In our case study the corpus luteum cyst rupture predominantly occurred in the right side, and the most suspectable cause was trauma such as coitus in the luteal phase.
Abdomen, Acute ; Ascitic Fluid ; Coitus ; Corpus Luteum* ; Female ; Hematoma ; Hemoperitoneum ; Humans ; Luteal Phase ; Menstrual Cycle ; Ovarian Cysts* ; Retrospective Studies ; Rupture

OBJECTIVE: Successful coil embolization of anterior communicating (A-com) artery aneurysms requires good visualization and understanding of the entire H complex. Bilateral carotid angiography may optimize anatomical understanding and visualization of the H complex. We therefore assessed the efficacy of simultaneous bilateral internal carotid angiography during coil embolization for A-com artery aneurysms. METHODS: Of the 153 patients with intracranial saccular aneurysms who underwent embolization between July 2008 and December 2009, 12 had A-com artery aneurysms and were embolized under bilateral carotid angiography. Patients were evaluated angiographically, immediately and 6 months (n=11) after embolization, using a 3-point scale (complete, residual neck, residual aneurysm). The safety, performance and efficacy of this approach were retrospectively evaluated. RESULTS: In all patients, bilateral internal carotid artery angiography provided more detailed anatomical information and understanding around the A-com artery, and, in complex situations, it allowed for more effective coil embolization through bilateral routes to the A-com artery. Angiography immediately after embolization showed occlusion of 11 of the 12 (92%) aneurysms, with none of these 11 showing evidence of recanalization at 6 months. CONCLUSION: These findings indicate that simultaneous bilateral carotid angiography during coil embolization of selected complex A-com artery aneurysms provided improved anatomical understanding, and resulted in more effective and safer procedures than typical unilateral angiography.
Aneurysm ; Angiography ; Arteries ; Carotid Artery, Internal ; Humans ; Intracranial Aneurysm ; Neck ; Retrospective Studies

We report three cases of a novel balloon remodelling technique across the anterior communicating artery (ACoA) through simultaneous bilateral internal carotid angiography. In all three cases, simultaneous bilateral carotid angiography for balloon-assisted coil embolisation of anterior communicating artery aneurysms (ACoAA) provided improved anatomical detail and resulted in effective and safe procedures compared to typical unilateral angiography.
Aneurysm ; Angiography ; Arteries ; Intracranial Aneurysm ; Neck

Intracranial mycotic aneurysms are secondary to infectious endocarditis, meningoencephalitis, cavernous sinus thrombophlebitis, sinusitis, and bacteremia. Usually mycotic aneurysms are arising on distal cerebral vessels, but rarely on internal carotid artery. We experienced mycotic aneurysm of ICA followed by meningoencephalitis and thrombophlebitis in both cavernous sinuses. We observed occurrence of mycotic aneurysm by sequential image, and good result after endovascular treatment. So we present our case.
Aneurysm, Infected* ; Bacteremia ; Carotid Artery, Internal* ; Cavernous Sinus ; Cavernous Sinus Thrombosis ; Endocarditis ; Intracranial Aneurysm ; Meningoencephalitis ; Sinusitis ; Thrombophlebitis

Subarachnoid hemorrhage (SAH) from vertebral artery (VA) dissecting aneurysms is rare and potentially fatal. Early rebleeding from ruptured VA dissecting aneurysms excessively reduces favorable outcome rates of the ruptured dissecting aneurysms, so that early diagnosis and treatment are essential for preventing early rebleeding and devastating results. A 52-year-old man was referred to our hospital due to an abruptly developed severe headache and sequential mental change. SAH due to ruptured left VA dissecting aneurysm was noted. We performed early endovascular internal trapping, and successful flow arrest on final angiogram was confirmed. About 6 hours later after internal trapping of the aneurysm, his mentality abruptly deteriorated and rebleeding was confirmed. We present this case of early rebleeding from vertebral dissecting aneurysm after endovascular internal trapping, along with a literature review.
Aneurysm ; Aneurysm, Dissecting* ; Early Diagnosis ; Headache ; Humans ; Middle Aged ; Subarachnoid Hemorrhage ; Vertebral Artery*

as useful as the conventional suction technique for the cytopathological evaluation of thyroid nodules.
Suction ; Thyroid Gland* ; Thyroid Nodule*