A major concern associated with carotid artery angioplasty and stenting (CAS) is a periprocedural distal cerebral embolization. To prevent distal embolization, embolic protection devices (EPDs) have been developed. However, the risk of cerebral embolism after protected CAS in patents with a vulnerable plaque is controversial and either a silent or a symptomatic stroke can occur despite the use of EPDs. Here, we report a case of a massive cerebral microemboli after a protected CAS using a distal filter EPD for a vulnerable plaque with a lipid rich necrotic core and intraplaque hemorrhage.

This study evaluated the quality characteristics of jelly prepared with different levels (0%, 5%, 10%, 15%, 20%, and 25%) of wild carrot (WC, Daucus carota L.) juice as a care food for the elderly. The lightness, redness, yellowness, and delta (Δ) values of the jelly (Control, WCJ5, WCJ10, WCJ15, WCJ20, and WCJ25) decreased with increasing amounts of wild carrot juice added. The mechanical properties, such as hardness, springiness, chewiness, and gumminess, of the jelly were decreased with increasing amounts of wild carrot juice added. The total polyphenol and total flavonoid contents of the jelly increased with increasing amounts of wild carrot juice added. The DPPH radical scavenging activity (IC50) also increased with increasing amounts of wild carrot juice added. The α-glucosidase inhibitory effects of wild carrot (WC) and WCJ25 were 71% and 54.4%, respectively, compared to the positive control (acarbose). The lipase inhibitory effects of WC and WCJ25 were 44.2% and 14.4%, respectively, compared to the positive control group (orlistat). On the other hand, the sensory evaluation score was the best at WCJ20, which contained 20% wild carrot juice. In conclusion, WCJ20 or WCJ25 is expected to be a care food for the elderly with respect to texture as well as the antioxidant and enzymatic activity (α-glucosidase inhibitory and lipase inhibitory activities).
Aged ; Daucus carota* ; Hand ; Hardness ; Humans ; Lipase

For securing large, giant, and wide-neck aneurysms, conventional coil embolization has substantial limitations, such as incomplete occlusion, recanalization, and a high recurrence rate. To overcome these limitations, a novel paradigm was suggested and, as a result, flow-diverting device was developed. The flow-diverting device is an innovative and effective technique to allow securing of large, giant, and wide-neck aneurysms. In numerous studies, the flow-diverting device has shown better outcomes than coil embolization. However, the flow-diverting device has also some risks, including rupture of aneurysm, intracerebral hemorrhage, and ischemic stroke. In addition, with more experience, unexpected complications are also reported.5) 7) In the present case, we experienced a delayed ischemic stroke at 27 days after endovascular treatment. The patient had multiple aneurysms and, among them, we treated a large posterior communicating artery aneurysm using Pipeline™ Embolization Device. The patient was tolerable for 25 days, but then suddenly presented intermittent right hemiparesis. In the initial diffusion magnetic resonance imaging (MRI), there was no acute lesion; however, in the follow-up MRI, an acute ischemic stroke was found in the territory of anterior choroidal artery which was covered by Pipeline Embolization Device. We suspect that neo-intimal overgrowth or a tiny thrombus have led to this delayed complication. Through our case, we learned that the neurosurgeon should be aware of the possibility of delayed ischemic stroke after flow diversion, as well as, long-term close observation and follow-up angiography are necessary even in the event of no acute complications.
Aneurysm ; Angiography ; Arteries ; Cerebral Hemorrhage ; Choroid ; Diffusion Magnetic Resonance Imaging ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Paresis ; Recurrence ; Rupture ; Stroke* ; Thrombosis

OBJECTIVE: To compare the apparent diffusion coefficient (ADC) value using single-shot echo-planar imaging sequences at 3T and 1.5T for differentiation of benign fracture edema and tumor infiltration of the vertebral body. MATERIALS AND METHODS: A total of 46 spinal examinations were included in the 1.5T MRI group, and a total of 40 spinal examinations were included in the 3T MRI group. The ADC values of the lesion were measured and calculated. The diagnostic performance of the conventional MR image containing sagittal T2-weighted fat saturated image and each diffusion weighted image (DWI) with an ADC value with different b values were evaluated. RESULTS: The mean ADC value of the benign lesions was higher than that of the malignant lesions on 1.5T and 3T (p < 0.05). The sensitivity of the diagnostic performance was higher with an additional DWI in both 1.5T and 3T, but the sensitivities were similar with the addition of b values of 400 and 1000. The specificities of the diagnostic performances did not show significant differences (p value > 0.05). The diagnostic accuracies were higher when either of the DWIs (b values of 400 and 1000) was added to routine MR image for 1.5T and 3T. Statistical differences between 1.5T and 3T or between b values of 400 and 1000 were not seen. CONCLUSION: The ADC values of the benign lesions were significantly higher than those of the malignant lesions on 1.5T and 3T. There was no statistically significant difference in the diagnostic performances when either of the DWIs (b values of 400 and 1000) was added to the routine MR image for 1.5T and 3T.
Diffusion ; Echo-Planar Imaging ; Edema* ; Magnetic Resonance Imaging* ; Spine

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

BACKGROUND: The DRAGON score is reportedly useful for predicting the outcome of intravenous thrombolysis. This study tested whether the modified DRAGON (mDRAGON) score, in which the onset-to-treatment time is extended, can predict the long-term outcome of transient ischemic stroke (AIS) patients who are candidates for mechanical thrombectomy (MT). METHODS: We assessed 40 AIS patients who were treated by MT alone or in combination with intravenous tissue plasminogen activator. The mDRAGON score is based on the following findings: hyperdense cerebral artery sign/early infarct signs on computed tomography (both=2, either=1, none=0), prestroke modified Rankin scale (mRS) score (>1=1), age (> or =80 years=2, 65-79 years=1, <65 years=0), glucose level (>144 mg/dL=1), onset-to-treatment time (>230 minutes=1), and baseline National Institutes of Health Stroke Scale score (>15=3, 10-15=2, 5-9=1, 0-4=0). Receiver operating characteristics (ROC) curve analysis was used to compare the performance of the mDRAGON score with the performances of other stroke prediction scores. RESULTS: Among 40 AIS patients treated with MT, the proportions with a good outcome (mRS score=0-2) in the groups with mDRAGON scores of 2 or 3, 4 or 5, 6 or 7, and 8-10 were 75%, 20%, 0%, and 0%, respectively, while the corresponding proportions with a poor outcome (mRS score=3-6) were 25%, 80%, 100%, and 100%. For the prediction of a good outcome at 3 months (mRS score=0-2), the area under the ROC curve of the mDRAGON scores was 0.87 (0.76-0.90). CONCLUSIONS: The mDRAGON score can be used to reliably predict the clinical outcome of AIS patients following endovascular treatment.
Cerebral Arteries ; Endovascular Procedures ; Glucose ; Humans ; National Institutes of Health (U.S.) ; Prognosis* ; ROC Curve ; Stroke* ; Thrombectomy* ; Tissue Plasminogen Activator

OBJECTIVE: We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases. MATERIALS AND METHODS: Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydrodissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed. RESULTS: The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance. CONCLUSION: Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.
Aged ; Child ; Female ; Foreign Bodies/*surgery/ultrasonography ; Humans ; Lower Extremity/*surgery/ultrasonography ; Male ; Middle Aged ; Soft Tissue Injuries/*surgery/ultrasonography ; Surgical Instruments

OBJECTIVE: A new double-lumen balloon catheter was being developed for the treatment of cerebral aneurysms. The purpose of this study is to report our initial experience of a double-lumen balloon catheter for the treatment of wide-necked aneurysms. MATERIALS AND METHODS: Seventeen patients (mean age, 63 years; range, 45-80 years) with wide-necked, with or without a branch-incorporated aneurysms, (10 ruptured and 9 unruptured) were treated with balloon-assisted coil embolization using a double-lumen balloon catheter (Scepter C(TM) or Scepter XC(TM)) for 7 months after being introduced to our country. Locations of the aneurysms were posterior communicating artery (n = 7), anterior communicating artery or A2 (n = 7), middle cerebral artery (MCA) bifurcation (n = 3), basilar artery tip (n = 1) and anterior choroidal artery (n = 1). The initial clinical and angiographic outcomes were retrospectively evaluated. RESULTS: Coil embolization was successfully completed in all 19 aneurysms, resulting in complete occlusions (n = 18) or residual neck (n = 1). In one procedure, a thrombus formation was detected at the neck portion of the ruptured MCA bifurcation aneurysm near to the end of the procedure. It was completely resolved with an intra-arterial infusion of Glycoprotein IIb/IIIa inhibitor (Tirofiban, 1.0 mg) without any clinical sequela. There were no treatment-related events in the remaining 18 aneurysms. At discharge, functional neurological state improved in 11 patients (10 patients with ruptured aneurysm and 1 with unruptured aneurysm presenting with mass symptoms) and 6 patients with unruptured aneurysms had no newly developed symptoms. CONCLUSION: In this preliminary case series, the newly developed double-lumen Scepter balloon appears to be a safe and convenient device for coil embolization of wide-necked aneurysms.
Aged ; Aged, 80 and over ; Aneurysm, Ruptured/diagnosis/*therapy ; Balloon Occlusion/*instrumentation ; *Catheters ; Cerebral Angiography ; Equipment Design ; Female ; Humans ; Intracranial Aneurysm/diagnosis/*therapy ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVE: To evaluate the feasibility and clinical and angiographic outcomes of stent-assisted embolization for complex middle cerebral artery (MCA) aneurysms. METHODS: The records of 23 consecutive patients with 24 MCA aneurysms, who underwent stent-assisted embolization of the aneurysm, were retrospectively evaluated. RESULTS: Fifteen aneurysms were treated with one stent and 8 were treated using more than two stents (5 a stent-within-a-stent, 1 triple stents, and two Y-stent). Angiographically, complete or near complete occlusion was achieved in 15 aneurysms (65.2%), residual neck in five (21.7%), and residual aneurysm in three (13.1%). Five aneurysms demonstrated thrombosis within the stent during the procedure and hospitalization, and were resolved by intraarterial and intravenous Tirofiban injection. Symptomatic thromboembolic complications were developed in five patients and permanent deficits demonstrated in two patients with modified Rankin Scale 1 and 2, respectively. Treatment-related permanent morbidity and mortality rates were 8.3% and 0% with relatively high complication rate. Angiographic follow-up was available in 17 aneurysms at 6-31 months (mean, 13.2 months) and showed stable or improved in 15 (88.2%) and major and minor recurrence in one, respectively. CONCLUSION: Complex MCA aneurysms could be treated by stent-assisted coiling and showed lower recanalization rate during mid-term follow-up by effective flow diversion due to various stent-assisted techniques. Our results warrant further study with a longer follow-up period in a larger sample.
Aneurysm ; Follow-Up Studies ; Hospitalization ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck ; Recurrence ; Retrospective Studies ; Stents ; Thrombosis ; Tyrosine

BACKGROUND AND OBJECTIVES: Thrombospondin-1 (TSP-1) is associated with atherosclerosis in animals with diabetes mellitus (DM). But, no study has investigated the role of TSP-1 in human atherosclerosis. This study investigated the relationship among plasma TSP-1 concentration, DM, and coronary artery disease (CAD). SUBJECTS AND METHODS: The study involved 374 consecutive subjects with suspected CAD, who had undergone coronary angiography to evaluate effort angina. Patients were divided into four groups as follows: DM(-) and CAD(-), DM(-) and CAD(+), DM(+) and CAD(-), and DM (+) and CAD(+). RESULTS: We found that plasma TSP-1 levels were higher in patients with DM(+) and CAD(+) (n=103) than those in other patients (n=271) (p<0.01). A multivariate analysis showed that male gender {odds ratio (OR), 2.728; 95% confidence interval (CI), 1.035-7.187}, high density lipoprotein-cholesterol (OR, 0.925; 95% CI, 0.874-0.980), glycated hemoglobin (OR, 1.373; 95% CI, 1.037-1.817), and plasma TSP-1 (OR, 1.004; 95% CI, 1.000-1.008) levels were independently associated with the presence of CAD in patients with DM. CONCLUSION: Plasma TSP-1 levels were higher in patients with DM(+) and CAD(+) than those in other patients, and plasma TSP-1 levels were independently associated with the presence of CAD in patients with DM. These findings show a possible link between human plasma TSP-1 concentration and CAD in patients with DM.
Aluminum Hydroxide ; Animals ; Atherosclerosis ; Carbonates ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Diabetes Mellitus ; Hemoglobins ; Humans ; Male ; Multivariate Analysis ; Plasma ; Thrombospondin 1