서론 대상 대상및방법 방법 1821

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1 Original Articles Korean Circulation J 1998;2811: 두개외경동맥협착증에대한스텐트삽입술의추적결과 윤영섭 1 홍범기 1 최동훈 1 김선호 2 김동익 3 김승민 4 장양수 1 심원흠 1 Follow-up Results of Stent Placement for Extracranial Carotid Artery Stenosis Young-Sup Yoon, MD 1, Bum-Kee Hong, MD 1, Dong-Hoon Choi, MD 1, Sun-Ho Kim, MD, 2 Dong-Ik Kim, MD 3, Seung-Min Kim, MD 4, Yangsoo Jang, MD 1 and Won Heum Shim, MD 1. 1 Division of Cardiology, Yonsei Cardiovascular Center, 2 Department of Neurosurgery, 3 Radiology, 4 Neurology, Yonsei University College of Medicine, Seoul, Korea ABSTRACT Background and ObjectivesCarotid artery stenting has evolved as a potential alternative to carotid endarterectomy in patients pts with significant carotid artery stenosis. We evaluated the feasibility and long-term outcome of carotid artery stenting in selected pts at high surgical risk. Materials and MethodsBetween May, 1996 and September 1998 we performed carotid artery stenting at 35 lesions in 25 pts. There were 23 males and 2 females. Mean age was range Eight four percent 21/25 of the pts had significant coronary artery disease. Sixty four percent 16/25 of the pts had significant peripheral artery lesions. Sixty percent 15/25 of the pts had neurologic symptoms or non-disabling stroke. We used Wallstent in 32 lesions and Palmaz stent in 3 lesions. Carotid stenting was undertaken in 33 internal carotid, 1 common carotid and 1 external carotid lesions. Bilateral carotid stenting was undertaken in forty percent 10/25 of the pts. Results Carotid stenting was successful in all lesions. One patient died due to massive cerebral hemorrhage 3 days after carotid stenting, who had und-erwent stenting as a rescue procedure for failed endarterectomy. One major stroke developed during procedure with partial recovery. For the combined endpoint of strokes and death within 30 days of procedure, the incidence was 8 and 5.7 in terms of pts and procedures, respectively. On follow-up 127 months, we found neither neurologic complications nor death. Angiographic and/or duplex sonography which were performed at 5.5 month in all 18 eligible pts with 24 lesions revealed no evidence of stent deformity or restenosis 50 of diameter stenosis. Mean angiographic stenosis was 20 on follow-up angiography. ConclusionCarotid artery stenting can be performed with high success and low complication rate in pts with significant carotid artery stenosis especially at high surgical risk. Follow-up clinical outcome of average 12 month was good with low restenosis rate. Korean Circulation J 1998;2811: KEY WORDSCarotid arteries Stenosis Stents Carotid endarterectomy. 1820

2 서론 대상 대상및방법 방법 1821

3 결과 임상특징 1822 혈관조영및시술결과 Table 1. Baseline clinical characteristics of patients N % Patients Mean agerange, year Male Coronary artery disease Peripheral artery disease Hypertension Smokerwithin 1 year Dibetes 8 32 Hypercholesterolemia NASCET exclusion criteria Symptomatic TIA 4 16 Stroke Previous endarterectomy 1 4 Bilateral carotid stenting Combined coronary stenting 8 32 Hypercholesterolemia:total cholesterol200 mg/dl Korean Circulation J 1998;2811:

4 Table 2. Target lesion characteristics N % Total Right common carotid 1 3 Left external carotid 1 3 Right internal carotid Left internal carotid Bilateral carotid Table 3. Angiographic results Unitmm Reference artery diameter MLD, prestent % diameter stenosis % MLD, poststent % diameter stenosis % MLD, follow up % diameter stenosis % acute gain Late loss % MLDminimal luminal diameter 추적관찰결과 고찰 1823

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7 요약 연구배경 : 대상및방법 : 1826 결과 : 결론 : 중심단어 REFERENCES 1) Friedman AH, Wilkins RH. Neurosurgical management, Baltimore Wiliams and Wilkins1984. p ) Hurst RW. Carotid angioplasty. Radiology ) North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefit of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med ) Executive commtittee for the Asymptomatic Carotid Atheroscl erosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA ) European Carotid Surgery Trialists Collaborative Group. Randomized trial of endarterectomy for recently symptomatic carotid stenosis final results of the MRC European carotid surgery tria ECST. Lancet ) Lusby RJ, Wylie EJ. Complications of carotid endarterectomy. Surg Clin North Am ) Kerber CW, Hornwell LD, Loehden OL. Catheter dilat- Korean Circulation J 1998;2811:

8 ion of proximal carotid stenosis during distal bifurcation endarterectomy. AJNR ) Diethrich EB, Ndiaye M, Reid DB. Stenting in the carotid artery. Initial experience in 110 patients. J Endovasc Surg ) Yadav JS, Roubin GS, King P, Iyer S, Vitek J. Angioplasty and stenting for restenosis after carotid endarterectomy. Stroke ) Therone JG, Payell GG, Coskun O, Huet HF, Guimaraens L. Carotid artery stenosis treatment with protected balloon angioplasty and stent placement. Radiology ) Shawl FA, Effstratiou A, Hoff S, Dougherty K. Combined carotid stenting and coronary angioplasty during acute ischemic neurologic and coronary syndromes. Am J Cardiol ) Shawl FA, Effstratiou A, Lapetina F, Dukovcic A, Hoff SB, Cornell S, et al. Percutaneous carotid intervention in patients wi th symptomatic coronary artery disease. J Am Coll Cardiol A. 13) Yadav JS, Roubin GS, Iyer S, Vitek J, King P, Jordan WD, et al. Elective stenting of the extracranial carotid arteries. Circulation ) Shim WH, Hong BK, Choi DH, Kim SH, Kim DI, Kim SM, et al. Early results of carotid artery stenting. Korean Circulation J ) Norris JW, Zhu CZ, Bornstein NM, Chambers BR. Vascular risks of asymptomatic carotid stenosis. Stroke ) Johnson BF, Verlado F, Bergelin RO, Primozich JF, Strandness E Jr. Clinical outcome in patients with mild and moderate carotid artery stenosis. J Vasc Surg ) Rockman CB, Riles TS, Lamparello PJ, Giangola G, Adelman HA, Stone D, et al. Natural history and management of the aymptomatic moderately stenotic internal carotid artery. J Vasc Surg ) Bock RW, Gray-Weale AC, Mock PA, App Stats M, Robinson DA, Irwig L, et al. The natural history of asymptomatic carotid artery occlusion. J Vasc Surg ) Winslow CM, Solomon DH, Chassin MR, Kosecoff J, Merrick NJ, Brook RH. The appropriateness of carotid endarterctomy. N Engl J Med ) Wholey MH, Wholey M, Bergeron P, Diethrich EB, Henry M, Laborde JC, et al. Current global state of carotid artery stent placement. Cath Cardiovasc Diagn ) Kang WC, Yoon YS, Choi DH, Shim WH. A case of transseptal approach to carotid artery stenting in right internal carotid stenosis. Korean Circulation J ) Zarins CK. Carotid endartectomy The gold standard. J Endovasc Surg ) Debakey MH. Carotid endarterectomy revisited. J Endovasc Surg ) Marcinczyk MJ, Nicholas GG, Reed JF, Nastasee SA. Asymptomatic carotid endarterectomy patient and surgeon selection. Stroke ) Wholey MH, Wholey M, Eles G, Levy D, Buechtal J. Endovascular stents for carotid occlusive disease. J Endovasc Surg ) Sundt. Sundt s Occlusive Cerebrovascular disease. 2nd ed. Phiadelphia: W.B. Saunders1994. p ) Moore WS, Barnett HJM, Beebe HG, Bernstein EF, Brener BJ, Brott J, et al. Guidelines for carotid endarterectomy A multicenter consensus statement from the ad hoc committee, American Heart Association. Stroke ) Edwards WH Jr, Edwards Sr, Mulherin JL, Martin RS. Recurrent carotid artery stenosis. Ann Surg ) Mathur A, Dorros G, Iyer S, Vitek J, Yadav JS, Roubin GS. Palmaz stent compression in patients with following carotid artery stenting. Cathet Cardiovasc Diagn ) Major ongoing stroke trials carotid and vertebral artery transluminal angioplasty study CAVATAS. Stroke ) Bettman MA, Katzen BT, Whisnant J, Brant-Zawadzki M, Boderick JP, Furian AJ, et al. Carotid stenting and angioplasty A statement for healthcare professionals from the councils on cardiovascular radiology, stroke, cardiovascular surgery, epidemiology, and prevention and clinical cardiology, American heart association. JVIR

노영남

노영남 Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding