Bo Yang Suh

Risk factor analysis of new brain lesions associated with carotid endarterectmy

Purpose Carotid endarterectomy (CEA) is the standard treatment for carotid artery stenosis. New brain ischemia is a major concern associated with CEA and diffusion weighted imaging (DWI) is a good imaging modality for detecting early ischemic brain lesions. We aimed to investigate the surgical complications and identify the potential risk factors for the incidence of new brain lesions (NBL) on DWI after CEA. Methods From January 2006 to November 2011, 94 patients who had been studied by magnetic resonance imaging including DWI within 1 week after CEA were included in this study. Data were retrospectively investigated by review of vascular registry protocol. Seven clinical variables and three procedural variables were analyzed as risk factors for NBL after CEA. Results The incidence of periprocedural NBL on DWI was 27.7%. There were no fatal complications, such as ipsilateral disabling stroke, myocardial infarction or mortality. A significantly higher incidence of NBL was found in ulcer positive patients as opposed to ulcer negative patients (P = 0.029). The incidence of NBL after operation was significantly higher in patients treated with conventional technique than with eversion technique (P = 0.042). Conclusion Our data shows CEA has acceptable periprocedural complication rates and the existence of ulcerative plaque and conventional technique of endarterectomy are high risk factors for NBL development after CEA.

Comparative results of conventional and eversion carotid endarterectomy.

Purpose Comparative results of conventional carotid endarterectomy (cCEA) and eversion carotid endarterectomy (eCEA) have been reported in many studies. But in Korea, there have been no reports to compare the outcome of the two techniques. Thus, we investigated the results of eCEA compared to cCEA in Yeungnam University Medical Center. Methods A total of 120 subjects who underwent CEA were included in this study. Of them, cCEAs were performed in 63 patients and eCEAs were performed in 57 patients. We analyzed the results divided into the early (within 30 days after surgery), midterm (from 30 days up to 1 year after surgery) and late (over 1 year after surgery). Results Mean age of the patients was 65.9 ± 7.1 years in cCEA group and 66.8 ± 7.7 years in eCEA group (P = 0.523). Carotid shunt frequency was higher in the cCEA group (39.7% vs. 19.3%, P = 0.015). There were no statistical differences in the early complications with the exception of a significantly higher risk for new brain lesions in the cCEA group (34.9% vs. 14.0%, P = 0.008). The frequency of complication was same between cCEA group and eCEA group in the midterm. Although there was no statistical significance, the frequency of late complications was higher in the cCEA group compared to eCEA group. Mean follow-up duration was 29.4 ± 23.5 months. Conclusion These data showed that eCEA was an acceptable procedure and had some advantage compared to cCEA in the aspect of the early and late complication.

Open-label, uncontrolled, 6-week clinical trial of beraprost in patients with chronic occlusive arterial disease

Abstract The efficacy and tolerability of beraprost sodium, sodium (±)-(1 R ,2 R ,3a S ,8b S )-2,3,3a,8b-tetrahydro-2-hydroxy-1-[(E)-(3 S ,4 RS )-3-hydroxy-4-methyl-1-octen-6-ynyl]-1H cyclopenta[ b ]benzofuran-5 butyrate, a prostacyclin analogue, were investigated in 23 patients (21 men and 2 women; mean age, 49.6 ± 15.4 years; mean body weight, 59.9 ± 8.0 kg) with chronic occlusive arterial disease and its complications, arteriosclerosis obliterans, and thromboangiitis obliterans with ischemic limb ulceration. In this open-label, uncontrolled study, beraprost was administered orally at a daily dosage of 40 μg (two 20-μg tablets) TID for 6 weeks. The subjective symptoms of rest pain and coldness of limbs improved in 14 patients (60.9%), and ischemic ulcer size and the appearance of granulation improved in 16 (69.6%) and 19 patients (82.6%), respectively. Ulcer size (calculated as the square root of the longest diameter × shortest diameter) at baseline (8.8 mm) had decreased significantly after 6 weeks of treatment (5.0 mm). One drug-related adverse event and several abnormal laboratory values were noted; however, all were mild and transient. These observations suggest that beraprost may be useful in treating chronic occlusive arterial diseases, and they support the need for controlled clinical studies of efficacy and tolerability in men and women.

The results of aspiration thrombecomy in the endovascular treatment for iliofemoral deep vein thrombosis

Purpose The aim of this study is to evaluate the results of aspiration thrombectomy (AT) in the endovascular treatment for iliofemoral deep vein thrombosis (DVT) through the comparison of catheter directed thrombolysis (CDT) alone group and CDT with AT group. Methods From November 2001 to April 2011, 100 patients received endovascular treatment with CDT alone or CDT with AT for iliofemoral DVT at Yeungnam University Medical Center. We compared procedure, clinical outcomes and complications between the two groups. Results The mean age of patients was 60.48 ± 14.57 years. The patients consisted of 41 men and 59 women. CDT alone and CDT with AT were performed in 29 and 71 patients, respectively. The mean procedural time of the CDT-alone group was longer than the CDT with AT group (P < 0.001) and dose of urokinase used during the procedure significantly decreased in the CDT with AT group (P < 0.001). There were no statistically significant differences in clinical outcomes between the two groups. Cases of pulmonary embolism was not noted in each group in our series, but entrapped thrombus during procedure was noted in 6 of 37 in the CDT with AT group and 0 of 9 in the CDT-alone group among 46 patients with prophylactic inferior vena cava (IVC) filter insertion. Conclusion In conclusion, CDT with AT is safe and effective for the treatment of an acute iliofemoral DVT. In AT treatment, prophylactic IVC filter insertion should be considered for the prevention of pulmonary embolism by floating thrombi.