Woo-Hyung Kwun

Carotid artery revascularization in patients with concomitant carotid artery stenosis and asymptomatic unruptured intracranial artery aneurysm.

BACKGROUND The incidence of concomitant carotid artery stenosis and unruptured intracranial aneurysm (UIA) has been reported to be between 3% and 5%. The rupture risk of UIA measuring <7 mm is very low according to International Study of Unruptured Intracranial Aneurysm data. However, there may be a potential risk of aneurysm rupture after carotid artery revascularization because of increased cerebral blood flow. The aims of this study were to investigate the incidence of concomitant UIA in patients who needed carotid artery intervention and to survey the incidence of aneurysm rupture after treatment. METHODS Between October 2004 and December 2009, 114 patients with severe carotid artery stenosis were treated in our hospital (69 carotid endarterectomies and 45 carotid artery stentings). Cerebral angiography and medical records were reviewed retrospectively. RESULTS Cerebral angiography revealed seven asymptomatic UIAs in six patients (5%, 6/114). Of them, four patients underwent carotid endarterectomy and two underwent carotid artery stenting. All patients were male, and the mean age of the patients was 72 years (range, 67-79 years). Aneurysm size ranged between 2.3 and 4.0 mm. Two patients had UIAs on the same side of the treated carotid artery, whereas others developed UIAs on the contralateral side. There was no periprocedural aneurysm rupture. During follow-up (mean: 18 months, 5-31 months), two patients died from other causes, and no rupture of aneurysm occurred in any of the patients. CONCLUSION In our series, the carotid artery revascularization did not have an effect on the natural course of small-sized asymptomatic UIA.

Adventitial cystic disease of common femoral vein

Adventitial cystic disease (ACD) of venous system is an extremely rare condition. Very few reports of ACD in venous system have been described. In this report we discuss two cases of common femoral vein ACD that presented with a swollen leg by the obstruction of the vein. Ultrasound imaging showed the typical hypoechoic fluid filled cyst with a posterior acoustic window. Computed tomography scan and ascending venogram showed a stenosis to flow in the common femoral vein caused by an extrinsic mass. Trans-adventitial evacuation of cyst with removal of vein wall was performed for both cases. During operation we found the gelatinous material in the cysts arising in the wall of the common femoral vein and compressing the lumen. The patients were released after short hospitalization and have remained symptom free with no recurrence.

The early and mid-term results of carotid artery stenting in high-risk patients

Purpose This study aimed to investigate early and mid-term outcomes of carotid artery stenting (CAS). Methods We retrospectively reviewed 111 patients who were treated for carotid stenosis between October 2004 and December 2009 (42 CASs and 69 carotid endarterectomies [CEAs]). Results CAS group was older than CEA group (70 years vs. 67 years, P = 0.001). Coronary artery disease and high lesion above the 2nd cervical vertebral body were more common in CAS group (29% vs. 13%, P = 0.002; 4% vs. 24%, P = 0.004). The 30-days stroke rate was higher in CAS group (10% vs. 1% in CEA group, P = 0.067, Fishers exact test). New brain lesions on diffusion-weighted magnetic resonance imaging were more common in CAS group (48% vs. 20% in CEA group, P = 0.002, chi-square test). The 1-, 3-year freedom from stroke were 91%, 84% in CAS group and 99%, 99% in CEA group (P = 0.007, log-rank test). Univariate analysis showed that female gender and age > 70 years were related with postprocedural neurological complications (P = 0.046 and P = 0.007, log-rank test). However, none were independent risk factors on multivariate analysis. Conclusion In our series, the rates of peri-procedural neurological complications in CAS group were significantly high. These results suggest that more experience and restricted patient selection will be needed for CAS.

Tacrolimus related neurologic complication after pediatric kidney transplantation.

Recently significant neurotoxicity has been reported with the use of carcineurin inhibitors. An 11-year-old-girl had undergone a transplantation of kidney from her mother. On post-operative day 12, hypertension, headache, and left motor weakness (grade I) suddenly occurred. The brain-magnetic resonance imaging and magnetic resonance angiography showed acute cerebral infarction at subcortical white matter of the right hemisphere and multiple stenoses of both anterior cerebral artery and middle cerebral artery. While stopping tacrolimus treatment, we experienced clinical and radiological improvement. So, the neurological complications of this patient seem to have been caused by the use of tacrolimus.