• Title, Summary, Keyword: Cerebral protection

Search Result 80, Processing Time 0.035 seconds

Direct Relationship between Angiographic Characteristics of Carotid Atherosclerotic Plaque and Filling Defect in the Cerebral Protection Filters : Based on the Conventional Angiography

  • Choi, Jae-Hyung;Park, Hyun-Seok;Kim, Dae-Hyun;Cha, Jae-Kwan;Huh, Jae-Taeck;Kang, Myongjin
    • Journal of Korean Neurosurgical Society
    • /
    • v.54 no.2
    • /
    • pp.93-99
    • /
    • 2013
  • Objective : Neurologic complications during carotid artery stenting (CAS) are usually associated with distal embolic event. These embolic incident during CAS are highly associated with the carotid plaque instability. The current study was undertaken to identify the angiographic characteristics of carotid plaque vulnerability, which was represented as filling defect in the cerebral protection filters during CAS. Methods : A total of 107 patients underwent CAS with use of a distal protection filter. Angiographic carotid plaque surface morphology was classified as smooth, irregular, and ulcerated. To determine predictable factors of filling defect in the protection filters, 11 variables were retrospectively analyzed which might influence filling defect in the protection filters during CAS. Results : Filling defects during CAS were presented in the 33 cerebral protection filters. In multivariate analysis, angiographic ulceration [odds ratio (OR), 6.60; 95% confidence interval (CI) : 2.24, 19.4; p=0.001], higher stenosis degree (OR, 1.06; 95% CI : 1.00, 1.12; p=0.039), and coexistent thrombus (OR, 7.58; 95% CI : 1.69, 34.05; p=0.08) were highly associated with filling defect in the cerebral protection devices during CAS. Among several variables, angiographic surface ulceration was the only significant factor associated with flow stagnation during CAS (OR, 4.11; 95% CI : 1.33, 12.72; p=0.014). Conclusion : Plaque surface morphology on carotid angiography can be a highly sensitive marker of plaque instability during CAS. The independent risk factors for filling defect in the filter devices during CAS were plaque ulceration, stenosis degree, and coexistent thrombus.

Experimental Study of Retrograde Cerebral Perfusion During Hypothermic Circulatory Arrest (초저체온 순환정지시 역행성 뇌혈 관류의 실험적 연구)

  • 김치경
    • Journal of Chest Surgery
    • /
    • v.26 no.7
    • /
    • pp.513-520
    • /
    • 1993
  • Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch still poses one of the most complicated technical and tactical challenges in surgery. The use of total circulatory arrest[TCA] with profound hypothermia in the surgical treatment of aneurysmal dissection involving the ascending aorta and aortic arch has been reported as popular surgical methods. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial and ischemic damage to the central nervous system and uncontrollable perioperative bleeding have been the major problem. We have found profound hypothermic circulatory arrest with retrograde cerebral perfusion via the superior vena cava to achieve cerebral protection. We experiment the aortic anastomosis in 7 adult mongrel dogs, using profound hypothermic circulatory arrest with continuous retrograde cerebral perfusion[RGCP] via superior vena cava. We also studied the extent of cerebral protection using above surgical methods, by gas analysis of retrograde cerebral perfusion blood and returned blood of aortic arch, preoperative, intraoperative and postoperative electroencephalography and microscopic findings of brain tissue. The results were as follows: 1. The cooling time ranged from 15 minutes to 24 minutes[19.71$\pm$ 3.20 minutes] ; Aorta cross clamp time ranged from 70 minutes to 89 minutes[79.86 $\pm$ 7.54 minutes] ; Rewarming time ranged from 35 minutes to 47 minutes[42.86$\pm$ 4.30 minutes] ; The extracorporeal circulation time ranged from 118 minutes to 140 minutes[128.43$\pm$ 8.98 minutes] [Table 2]. 2. The oxygen content in the oxygenated blood after RGCP was 12.66$\pm$ 1.25 ml/dl. At 5 minutes after the initiation of RGCP, the oxygen content of returnedlood was 7.58$\pm$ 0.21 ml/dl, and at 15 minutes 7.35$\pm$ 0.17 ml/dl, at 30 minutes 7.20$\pm$ 0.19 ml/dl, at 60 minutes 6.63$\pm$ 0.14 ml/dl [Table 3]. 3. Intraoperative electroencephalographic finding revealed low amplitude potential during hypothermia, and no electrical impulse throughout the period of circulatory arrest and RGCP. Electrical activity appeared after reperfusion, and the electroencephalographic reading also recovered rapidly as body temperature returned to normal [Fig. 2]. 4. The microscopic finding of brain tissue showed widening of the interfibrillar spaces. But there was no evidence of tissue necrosis or hemorrhage [Fig. 3]. We concluded the retrograde cerebral perfusion during hypothermic circulatory arrest is a simplified technique that may have a excellent brain protection.

  • PDF

Clinical Analysis Comparing Efficacy between a Distal Filter Protection Device and Proximal Balloon Occlusion Device during Carotid Artery Stenting

  • Lee, Jong Hyeok;Sohn, Hee Eon;Chung, Seung Young;Park, Moon Sun;Kim, Seong Min;Lee, Do Sung
    • Journal of Korean Neurosurgical Society
    • /
    • v.58 no.4
    • /
    • pp.316-320
    • /
    • 2015
  • Objective : The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device. Methods : From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ${\geq}70%$ were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates. Results : CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group). Conclusion : Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.

Expression and Significance of MicroRNA155 in Serum of Patients with Cerebral Small Vessel Disease

  • Guo, Ying;Li, Dongxue;Li, Jiapei;Yang, Nan;Wang, Deyun
    • Journal of Korean Neurosurgical Society
    • /
    • v.63 no.4
    • /
    • pp.463-469
    • /
    • 2020
  • Objective : This study aimed to investigate the changes and significance of microRNA155 levels in serum of patients with cerebral small vessel disease (CSVD). Methods : Thirty patients with CSVD who met the inclusion criteria were selected and divided into eight patients with lacunar infarction (LI) group and 22 patients with multiple lacunar infarction (MLI) combined with white matter lesions (WML) group according to the results of head magnetic resonance imaging (MRI). Thirty samples from healthy volunteers without abnormalities after head MRI examination were selected as the control group. The levels of serum microRNA155 in each group were determined by real-time polymerase chain reaction, and the correlation between microRNA155 in the serum of patients with CSVD and the increase of imaging lesions was analyzed by Spearman correlation analysis. Results : Compared with the control group, the serum microRNA155 level in the LI group, MLI combined with WML group increased, the difference was statistically significant (p<0.05); serum microRNA155 level was positively correlated with the increase of imaging lesions (p<0.05). Conclusion : The change of serum microRNA155 level in patients with CSVD may be one of its self-protection mechanisms, and the intensity of this self-protection mechanism is positively correlated with the number of CSVD lesions.

In Situ Floating Resin Cranioplasty for Cerebral Decompression

  • Ahn, Duck-Hyung;Kim, Dae-Won;Kang, Sung-Don
    • Journal of Korean Neurosurgical Society
    • /
    • v.46 no.4
    • /
    • pp.417-420
    • /
    • 2009
  • The purpose of this report is to describe our surgical experiences in the treatment of cerebral decompression with in situ floating resin cranioplasty. We included in this retrospective study 7 patients who underwent in situ floating resin cranioplasty for cerebral decompression between December 2006 and March 2008. Of these patients, 3 patients had traumatic brain injury, 3 cerebral infarction, and one subarachnoid hemorrhage due to aneurysmal rupture. In situ floating resin cranioplasty for cerebral decompression can reduce complications related to the absence of a bone flap and allow reconstruction by secondary cranioplasty without difficulty. Furthermore, it provides cerebral protection and selectively eliminates the need for secondary cranioplasty in elderly patients or patients who have experienced unfavorable outcome.

Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature

  • Cho, Young Dae;Kim, Sung-Eun;Lim, Jeong Wook;Choi, Hyuk Jai;Cho, Yong Jun;Jeon, Jin Pyeong
    • Journal of Korean Neurosurgical Society
    • /
    • v.61 no.4
    • /
    • pp.458-466
    • /
    • 2018
  • Objective : To compare peri-operative any symptomatic stroke after carotid angioplasty and stenting (CAS), based on the application or absence of a cerebral protection device. Methods : A systematic literature review using PubMed, Embase, and the Cochrane Central was done across an online data base from January 1995 to October 2016. Procedures which were performed due to carotid dissection or aneurysm, procedures using covered stents or conducted in an emergency, were excluded. The primary endpoint was perioperative any symptomatic stroke within 30 days after the procedure. A fixed effect model was used in cases of heterogeneity less than 50%. Results : In the 25 articles included in this study, the number of stroke events was 326 (2.0%) in protected CAS and 142 (3.4%) in unprotected CAS. The use of cerebral protection device significantly decreased stroke after CAS (odds ratio [OR] 0.633, 95% confidence interval [CI] 0.479-0.837, p=0.001). In the publication bias analysis, Egger's regression test disclosed that the intercept was -0.317 (95% CI -1.015-0.382, p=0.358). Regarding symptomatic patients (four studies, 539 CAS procedures), the number of stroke was six (1.7%) in protected CAS and 11 (5.7%) in unprotected CAS. The protective effect against stroke events by cerebral protection device did not have a statistical significance (OR 0.455, 95% CI 0.151-1.366, p=0.160). Conclusion : The use of protection device significantly decreased stroke after CAS. However, its efficacy was not demonstrated in symptomatic patients. Routine use of protection device during CAS should be critically assessed before mandatory use.

The Effect of Sohabhyangwon(蘇合香元) on Regional Cerebral Blood Flow and Area of Cerebral Infarction in the Experimentally induced Cerebral Infarction in Rats (소합향원(蘇合香元)이 실험적(實驗的) 뇌경색(腦梗塞) 흰쥐의 국소뇌혈류량(局所腦血流量) 및 경색(梗塞) 면적에 미치는 영향(影響))

  • Choi, Eun-Jeong;Shin, Gil-Cho;Lee, Won-Chul
    • The Journal of Korean Medicine
    • /
    • v.18 no.1
    • /
    • pp.456-469
    • /
    • 1997
  • The cerebral infarction arised from occulsion of cerebral artery has a high mortality rate and fatal sequelae. Sohabhyangwon(蘇合香元) is generally regarded to have a effect of walking up the patient from unconsiousness and promoting the flow of Qj(氣) by warming channel. METHOD The purpose of this study is to find out the effections of Sohabhyangwon(蘇合香元) on regional cerebral blood flow and relative cerebral infarction area in the experimentally induced infartion in rats In this experiment, 12 Spraque-Dawley rats weighting 280-350g were used. Cerebral ischemia induced by intraluminal suture technique of Kozumi's and Zea-Longer's method. $Co_{2},\;O_2$, pH, arterial blood pressure in rats were checked by Blood Gas Analyzer every 30 minutes for 2 hours. And regional cerebral blood flow were checking by hydrogen clearance technique, cerebral infarcted area was megsured by Image Analysis System. RESULTS 1. During the experiment, $CO_{2},\;O_2$, pH, arterial blood pressure in rats had no change in both sample group and control group. 2. Cortical cerebral blood flow decreased at same rate in both sample group and control group after inducing cerebral infarction. 3. On comparison of relative cerebral infarcted area, Sohabhyangwon(蘇合香元) perfused group showed a significant decrease. CONCLUSION According to the result above, Sohabhyangwon has a protection effect on cranial nerve and-has no effect on cerebral blood flow.

  • PDF

Effect of Aconiti Radix on Cultured Cerebral Neurons Damaged by Reactive Oxygen Species (활성산소로 손상된 대뇌신경세포에 대한 천오두의 영향)

  • Shim Jae Han;Lee Eun Mi;Lee Joung Hwa;Kim Dae Geun;Lee Young Chan;Kang Jeong Ho;Park Sin Kee
    • Journal of Physiology & Pathology in Korean Medicine
    • /
    • v.17 no.2
    • /
    • pp.499-502
    • /
    • 2003
  • Neurotoxicity of reactive oxygen species(ROS) and neuroprotective effect of Aconiti Radix(AR) against ROS-induced cytotoxicity were determined on cultured mouse cerebral neurons by MTT assay after cerebral neurons were cultured for 5 hours in various concentrations of GO. GO was toxic in a dose-dependent manner on cultured cerebral neurons after cerebral neurons were incubated for 5 hours in media containing 5~40mU/ml GO. While, cultures were pretreated with 180 μg/ml AR for 2 hours increased remarkably cell viability. From these results, it is suggested that GO has toxic effect on cultured mouse cerebral neurons by the decrease of cell viability. And also, herb extract such as AKR is very effective in the protection pf neurotoxicity induced by GO.

Effects of Snake Venom Pharmacopuncture on a Mouse model of Cerebral Infarction

  • Choi, Chul-Hoon;Song, Ho-Sueb
    • Journal of Acupuncture Research
    • /
    • v.36 no.3
    • /
    • pp.140-146
    • /
    • 2019
  • Background: This study investigated the effects of Vipera lebetina turanica snake venom (SV) on cerebral infarction induced by middle cerebral artery occlusion in mice. Methods: Following cerebral infarction, SV was injected intravenously or added to BV2 cell culture. Tissue injury was detected using triphenyltetrazolium chloride (TTC) staining, neurological deficit score, NO, ROS, and GSH/GSSG assays, qPCR, Western blot, and cell viability. Results: Cerebral infarction caused by middle cerebral artery occlusion as observed by TTC staining, showed SV inhibited cell death, reducing the number of brain cells injured due to infarction. SV treatment for cerebral infarction showed a significant decrease in abnormal behavior, as determined by the neurological deficit score. The oxidation and inflammation of the cells that had cerebral infarction caused by middle cerebral artery occlusion (NO assay, ROS, GSH/GSSG assay, and qPCR), showed significant protection by SV. Western blot of brain infarction cells showed the expression of iNOS, COX-2, p-IkB-${\alpha}$, P38, p-JNK, p-ERK to be lower in the SV group. In addition, the expression of IkB increased. BV2 cells were viable when treated with SV at $20{\mu}g/mL$ or less. Western blot of BV2 cells, treated with 0.625, 1.5, $2.5{\mu}g/mL$ of SV, showed a significant decrease in the expression of p-IkB-${\alpha}$, p-JNK, iNOS, and COX-2 on BV2 cells induced by LPS. Conclusion: SV showed anti-inflammatory and anti-oxidant effects against cerebral infarction and inflammation.

Effects of Sokmyeung-tang(SMT) on the Protection of C6 Glial Cells and Ischemic Brain Damage (속명탕(續命湯)이 C6 glial cell 보호 및 허혈성 뇌손상에 미치는 영향)

  • An, Ga-Yong;Choi, Eun-Hee;Kim, In-Soo;Kang, Seong-Sun;Lee, Young-Soo;Hong, Seok;Jeon, Sang-Yun
    • The Journal of Internal Korean Medicine
    • /
    • v.32 no.1
    • /
    • pp.43-55
    • /
    • 2011
  • Objectives : Sokmyeung-tang(SMT) has been used for treatment of CVA in traditional oriental medicine, so this study was designed to evaluate the effect of SMT's protection on brain cell damage against the oxidative stress that was affected by CVA, We also investigated the effect of motor function improvement and neurotrophic factor in ischemic cerebral damaged rats. Methods : We measured cell viability after administrating SMT, chemicals(Paraquat, SNP, rotenone, and $H_2O_2$) which cause oxidative stress, and both SMT and chemicals. We carried out neurobehavioral evaluation(Rotarod test, Beam-walking test, postural reflex test) and observed BDNF (brain-derived neurotrophic factor) expression by injecting SMT into ischemic cerebral damaged rat. Results : Through this study, we observed the following three results. First, brain cell death caused by paraquat, rotenone, and $H_2O_2$ significantly decreased with the treatment of SMT. Second, neuronal movement function in ischemic cerebral damaged rats was significantly improved by the treatment of SMT. Third, BDNF in ischemic cerebral damaged rats increased with the treatment of SMT. Conclusions : SMT protects brain cells from damage induced by oxidative stress (Paraquat, rotenone, $H_2O_2$). SMT also improves neuronal movement function and increases BDNF in ischemic cerebral damaged rats.