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Article: Facilitated Retrograde Access via the Facial Vein for Transvenous Embolization of the Cavernous Sinus Dural Arteriovenous Fistula with Isolated Ophthalmic Venous Drainage.

AlAli, Meshari / Kwon, Boseong / Song, Yunsun / Lee, Deok Hee

2024 Volume 19, Issue 1, Page(s) 39–44

Abstract: Management of cavernous sinus dural arteriovenous fistula (CSDAVF) continues to present significant challenges, particularly when the inferior petrosal sinus is thrombosed, collapsed, or angiographically invisible. In this study, we introduce facilitated ...

Abstract	Management of cavernous sinus dural arteriovenous fistula (CSDAVF) continues to present significant challenges, particularly when the inferior petrosal sinus is thrombosed, collapsed, or angiographically invisible. In this study, we introduce facilitated retrograde access via the facial vein, which is employed in the transvenous embolization of CSDAVF with isolated superior ophthalmic venous drainage. We also present illustrative cases and technical points.
Language	English
Publishing date	2024-01-12
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2639823-0
ISSN	2233-6273 ; 2093-9043
ISSN (online)	2233-6273
ISSN	2093-9043
DOI	10.5469/neuroint.2023.00493
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Flow Diverter Treatment Using a Flow Re-Direction Endoluminal Device for Unruptured Intracranial Vertebral Artery Dissecting Aneurysm: Single-Center Case Series and Technical Considerations.

Suh, Dae Chul / Song, Yunsun / Park, Sang Ik / Kwon, Boseong

Neurointervention

2023 Volume 18, Issue 2, Page(s) 114–122

Abstract: Purpose: This study aimed to evaluate the effectiveness, safety, and technical considerations of flow diverter (FD) treatment using a Flow Re-direction Endoluminal Device (FRED) for unruptured intracranial vertebral artery dissecting aneurysms (VADAs).!# ...

Abstract	Purpose: This study aimed to evaluate the effectiveness, safety, and technical considerations of flow diverter (FD) treatment using a Flow Re-direction Endoluminal Device (FRED) for unruptured intracranial vertebral artery dissecting aneurysms (VADAs). Materials and methods: We conducted a retrospective study of 23 patients with unruptured intracranial VADAs who underwent FD treatment using a FRED between June 2017 and August 2021. Symptoms, imaging findings, treatment strategies, and angiographic and clinical outcomes were evaluated. Dissections were categorized according to the dominance of the VA in which they occurred: dominant VA, co-dominant VA, and non-dominant VA. Results: All patients successfully underwent FD treatment with either a FRED (n=11) or FRED Jr. (n=12). Complete occlusion rates were 78.3% at 6-month follow-up magnetic resonance angiography and 91.3% at 12-month. There were no instances of complications, recurrence, or retreatment during a median follow-up of 20 months. Dissections occurred in the dominant VA in 3 cases (13.0%), the co-dominant VA in 13 cases (56.5%), and the non-dominant VA in 7 cases (30.4%). Intimal flap and true lumen stenosis were observed in 39.1% and 30.4% of cases, respectively. Four cases required a bilateral VA approach due to technical difficulties, all in the non-dominant VA. Conclusion: Flow diversion treatment using a FRED for unruptured intracranial VADAs proved feasible and safe, yielding satisfactory occlusion rates. Technical challenges were more likely in lesions involving non-dominant VAs in the acute or subacute stage, mainly due to associated intraluminal lesions compromising the arterial lumen.
Language	English
Publishing date	2023-06-20
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2639823-0
ISSN	2233-6273 ; 2093-9043
ISSN (online)	2233-6273
ISSN	2093-9043
DOI	10.5469/neuroint.2023.00199
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Article: Physiologic Flow Diversion Coiling Technique for Wide-Necked Aneurysms with an Asymmetric Bidirectional Flow at the Aneurysm Neck.

Kwon, Boseong / Song, Yunsun / Choi, Yun Hyeok / Suh, Dae Chul

Neurointervention

2022 Volume 17, Issue 3, Page(s) 133–142

Abstract: Purpose: Wide-necked aneurysms in the circle of Willis (CoW) are prone to recur due to reciprocal bidirectional flow. We present a novel concept of coil embolization to prevent recurrence that uses physiologic flow diversion at the CoW.: Materials and ...

Abstract	Purpose: Wide-necked aneurysms in the circle of Willis (CoW) are prone to recur due to reciprocal bidirectional flow. We present a novel concept of coil embolization to prevent recurrence that uses physiologic flow diversion at the CoW. Materials and methods: We enrolled 14 patients (15 aneurysms) who underwent aneurysm coiling for wide-necked aneurysms with asymmetric bidirectional inflow into the aneurysm. Four patients had recurrent aneurysms after coiling. The concept of physiologic flow diversion included obliterating antegrade flow into the aneurysm sac as well as opposite CoW flow by performing compact coil packing with intentional protrusion out of the aneurysm neck to the communicating part. Results: Fifteen aneurysms, including 4 recurrent aneurysms, in an anterior communicating artery (n=7), posterior communicating artery (n=5), and tip of the basilar artery (n=3) were treated with coil embolization (n=10) and stent-assisted coiling (n=5). All aneurysms had a wide neck, and the mean largest diameter was 9.0 mm. The mean packing density was 45.1%. Twelve aneurysms were completely occluded, and 3 aneurysms had tiny residual neck remnants. There was neither a neurological event nor recurrence during the mean 12.5 months of follow-up. Conclusion: Wide-necked aneurysms at the CoW tend to recur. As a strategy to prevent a recurrence, physiologic flow diversion can be an option in treating wide-necked aneurysms in the CoW.
Language	English
Publishing date	2022-09-28
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2639823-0
ISSN	2233-6273 ; 2093-9043
ISSN (online)	2233-6273
ISSN	2093-9043
DOI	10.5469/neuroint.2022.00311
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Article: In Vitro Head-to-Head Comparison of Flow Reduction between Fibered and Non-Fibered Pushable Coils.

Yoon, Jong-Tae / Kwon, Boseong / Choi, Joon Ho / Hwang, Sun Moon / Kim, Mihyeon / Hwang, Sungbin / Song, Yunsun / Lee, Deok Hee

Neurointervention

2024 Volume 19, Issue 1, Page(s) 31–38

Abstract: Purpose: To compare the embolization effects of a non-fibered pushable coil with a conventional fibered pushable coil in an in vitro bench-top experiment.: Materials and methods: A simplified vascular phantom with 4 channels (1 for the non-fibered ... ...

Abstract	Purpose: To compare the embolization effects of a non-fibered pushable coil with a conventional fibered pushable coil in an in vitro bench-top experiment. Materials and methods: A simplified vascular phantom with 4 channels (1 for the non-fibered coil, 1 for the fibered coil, and 2 for continuous circuit flow) was used. A single coil of the longest length was inserted to evaluate the effect of single-coil embolization, and 3 consecutive coils were inserted to assess the effect of multiple-coil embolization. Post-embolization angiography was performed to obtain flow variables (time to peak [TTP], relative peak intensity [rPI], and angiographic flow reduction score [AFRS]) from time density curves. The packing densities of the two coil types were calculated, and the AFRS of each channel was determined by dividing the TTP by the rPI. Results: When inserting a single coil, the conventional fibered coil demonstrated better flow reduction, as indicated by a higher AFRS (25.6 vs. 17.4, P=0.034). However, the non-fibered coil exhibited a significantly higher packing density (12.9 vs. 2.4, P=0.001). Similar trends were observed with multiple coils. Conclusion: The conventional fibered pushable coil showed better flow reduction efficiency, while the non-fibered pushable coil had a higher packing density, likely due to the flexibility of the coil loops. A better understanding of the distinct characteristics of different pushable coils can enhance the outcomes of various vascular embolization.
Language	English
Publishing date	2024-02-20
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2639823-0
ISSN	2233-6273 ; 2093-9043
ISSN (online)	2233-6273
ISSN	2093-9043
DOI	10.5469/neuroint.2024.00031
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Article: Author Correction: In Vitro Head-to-Head Comparison of Flow Reduction between Fibered and Non-Fibered Pushable Coils.

Yoon, Jong-Tae / Kwon, Boseong / Choi, Joon Ho / Hwang, Sun Moon / Kim, Mihyeon / Hwang, Sungbin / Song, Yunsun / Lee, Deok Hee

Neurointervention

2024

Language	English
Publishing date	2024-03-14
Publishing country	Korea (South)
Document type	Journal Article ; Published Erratum
ZDB-ID	2639823-0
ISSN	2233-6273 ; 2093-9043
ISSN (online)	2233-6273
ISSN	2093-9043
DOI	10.5469/neuroint.2024.00031.e1
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Article: Ruptured Medullary Hemangioblastoma Mimicking a Craniocervical Junction Dural Arteriovenous Fistula with a Pseudoaneurysm.

Park, Sangil / Kwon, Boseong / Lee, Deok Hee / Ahn, Jae-Sung / Song, Yunsun

Neurointervention

2023 Volume 18, Issue 3, Page(s) 209–213

Abstract: Hemangioblastomas (HBMs) are rare vascular tumors commonly located in the posterior fossa of adults. A mid-50s patient presented with sudden unconsciousness. Computed tomography scans revealed acute hemorrhages around the posterior fossa, predominantly ... ...

Abstract	Hemangioblastomas (HBMs) are rare vascular tumors commonly located in the posterior fossa of adults. A mid-50s patient presented with sudden unconsciousness. Computed tomography scans revealed acute hemorrhages around the posterior fossa, predominantly in the subarachnoid space. Digital subtraction angiography (DSA) revealed an 8-mm round lesion filled with contrast agent, fed by the C1 segmental artery of the left vertebral artery (VA), showing early venous drainage to the spinal cord and brainstem. Emergent embolization was attempted under suspicion of a ruptured dural arteriovenous fistula, resulting in parent artery occlusion due to feeder selection failure. Follow-up DSA after a month depicted a persistent aneurysm via collaterals from both VAs. Consequently, the decision was made to proceed with surgical intervention, leading to the resection of the lesion, confirming its diagnosis as a HBM through histological examination. This case underscores the potential for misdiagnosis when HBMs with an intratumoral shunt mimic vascular shunt lesions.
Language	English
Publishing date	2023-10-23
Publishing country	Korea (South)
Document type	Case Reports
ZDB-ID	2639823-0
ISSN	2233-6273 ; 2093-9043
ISSN (online)	2233-6273
ISSN	2093-9043
DOI	10.5469/neuroint.2023.00451
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Article ; Online: The influence of contralateral circulation on computational fluid dynamics of intracranial arteries: simulated versus measured flow velocities.

Oh, SuJeong / Song, YunSun / Lim, HyunKyung / Ko, YoungBae / Park, SungTae

European radiology experimental

2023 Volume 7, Issue 1, Page(s) 55

Abstract: Background: This study aimed to retrospectively evaluate the influence of contralateral anterior circulation on computational fluid dynamics (CFD) of intracranial arteries, by comparing the CFD values of flow velocities in unilateral anterior ... ...

Abstract	Background: This study aimed to retrospectively evaluate the influence of contralateral anterior circulation on computational fluid dynamics (CFD) of intracranial arteries, by comparing the CFD values of flow velocities in unilateral anterior circulation with the measured values from phase-contrast magnetic resonance angiography (PC-MRA). Methods: We analyzed 21 unilateral anterior circulation models without proximal stenosis from 15 patients who performed both time-of-flight MRA (TOF-MRA) and PC-MRA. CFD was performed with the inflow boundary condition of a pulsatile flow of the internal carotid artery (ICA) obtained from PC-MRA. The outflow boundary condition was given as atmospheric pressure. Simulated flow velocities of the middle cerebral artery (MCA) and anterior cerebral artery (ACA) from CFD were compared with the measured values from PC-MRA. Results: The velocities of MCA were shown to be more accurately simulated on CFD than those of ACA (Spearman correlation coefficient 0.773 and 0.282, respectively). In four models with severe stenosis or occlusion of the contralateral ICA, the CFD values of ACA velocities were significantly lower (< 50%) than those measured with PC-MRA. ACA velocities were relatively accurately simulated in the models including similar diameters of both ACAs. Conclusion: It may be necessary to consider the flow condition of the contralateral anterior circulation in CFD of intracranial arteries, especially in the ACA. Relevance statement: Incorporating the flow conditions of the contralateral circulation is of clinical importance for an accurate prediction of a rupture risk in Acom aneurysms as the bidirectional flow and accurate velocity of both ACAs can significantly impact the CFD results. Key points: • CFD simulations using unilateral vascular models were relatively accurate for MCA. • Contralateral ICA steno-occlusion resulted in an underestimation of CFD velocity in ACA. • Contralateral flow may need to be considered in CFD simulations of ACA.
MeSH term(s)	Humans ; Constriction, Pathologic ; Hydrodynamics ; Retrospective Studies ; Arteries ; Pulsatile Flow
Language	English
Publishing date	2023-09-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2509-9280
ISSN (online)	2509-9280
DOI	10.1186/s41747-023-00370-9
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Article ; Online: Mass Effect After Flow Diversion for Unruptured Large and Giant Cavernous or Paraclinoid Internal Carotid Artery Aneurysm.

Moon, Eunji / Park, Wonhyoung / Song, Yunsun / Lee, Deok Hee / Ahn, Jae Sung / Park, Jung Cheol

World neurosurgery

2023 Volume 180, Page(s) e108–e116

Abstract: Objective: The mass effect associated with large or giant intracranial aneurysms is difficult for traditional endovascular treatment. This study investigated whether flow diverters can relieve the aneurysmal mass effect caused by aneurysmal compression ... ...

Abstract	Objective: The mass effect associated with large or giant intracranial aneurysms is difficult for traditional endovascular treatment. This study investigated whether flow diverters can relieve the aneurysmal mass effect caused by aneurysmal compression symptoms. Methods: Fifty-five patients with unruptured large and giant intracranial aneurysms treated by a flow diverter at our institution from January 2014 to February 2022 were retrospectively evaluated. Results: In this study, 53 patients were included. Initially, 27 patients (51.9%), including 10 with compressive optic neuropathy, 12 with third nerve palsy, 2 with facial hyperesthesia, and 11 with sixth nerve palsy, were symptomatic. The symptom duration was shorter in the improved group (n = 2.2 ± 4.0 vs. n = 3.1 ± 3.9, P = 0.49). Thrombus formation following the flow diversion procedure was typically observed on magnetic resonance imaging (MRI) performed immediately and was not significantly associated with symptomatic improvement (OR = 0.395; 95% CI (0.058-2.698), P = 0.343). However, symptomatic improvement was seen in most patients when the aneurysm size decreased on MRI. A reduction in the aneurysm size on the MRI at the 3-month follow-up was correlated with symptomatic improvement in the multivariate analysis (OR = 0.08, 95% CI (0.013-0.485), P < 0.05). Conclusions: A flow diverter might help alleviate compression symptoms caused by large or giant intracranial aneurysms. Shrinkage of the aneurysm within 3 months postoperatively and a shorter duration of symptoms contribute to the favorable outcomes of mass effect. Ultimately, prompt treatment is crucial for improving symptomatic intracranial artery aneurysms.
MeSH term(s)	Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/surgery ; Intracranial Aneurysm/complications ; Retrospective Studies ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/surgery ; Endovascular Procedures/methods ; Embolization, Therapeutic/methods ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/surgery ; Carotid Artery Diseases/complications ; Treatment Outcome ; Stents
Language	English
Publishing date	2023-09-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2023.08.129
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Article: Embolization Tactics of Spinal Epidural Arteriovenous Fistulas.

Al-Abdulwahhab, Abdulrahman Hamad / Song, Yunsun / Kwon, Boseong / Suh, Dae Chul

Neurointervention

2021 Volume 16, Issue 3, Page(s) 252–259

Abstract: Purpose: Spinal epidural arteriovenous fistulas (SEDAVFs) show an epidural venous sac often with venous congestive myelopathy (VCM) due to intradural reflux at a remote level to which a transarterial approach would be difficult. We present 12 cases of ... ...

Abstract	Purpose: Spinal epidural arteriovenous fistulas (SEDAVFs) show an epidural venous sac often with venous congestive myelopathy (VCM) due to intradural reflux at a remote level to which a transarterial approach would be difficult. We present 12 cases of SEDAVF with VCM and describe 3 main tactics for effective transarterial embolization. Materials and methods: Among 152 patients with spinal vascular malformations diagnosed in our tertiary hospital between 1993 and 2019, 12 SEDAVF patients with VCM were included. Three different transarterial embolization tactics were applied according to the vascular configuration and microcatheter accessibility. We evaluated treatment results and clinical outcomes before and after treatment. Results: Transarterial embolization with glue (20-30%) was performed in all patients. The embolization tactics applied in 12 patients were preferential flow (n=2), plug-and-push (n=6), and filling of the venous sac (n=4). Total occlusion of the SEDAVF, including intradural reflux, was achieved in 11 (91.7%) of 12 patients, and partial occlusion was achieved in 1 patient. No periprocedural complications were reported. Spinal cord edema was improved in all patients for an average of 18 months after treatment. Clinical functional outcome in terms of the pain, sensory, motor, and sphincter scale and modified Rankin scores improved during a mean 25-month follow-up (6.3 vs. 3.3, P=0.002; 3.6 vs. 2.3, P=0.002, respectively). Conclusion: Endovascular treatment for 12 SEDAVF patients with VCM achieved a total occlusion rate of 91.7% without any periprocedural complication. The combined embolization tactics can block intradural reflux causing VCM, resulting in overall good clinical outcomes.
Language	English
Publishing date	2021-08-24
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2639823-0
ISSN	2233-6273 ; 2093-9043
ISSN (online)	2233-6273
ISSN	2093-9043
DOI	10.5469/neuroint.2021.00220
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Article: Safety and Effectiveness of the Novel Catheter 3.0 System for Diagnostic Cerebral Angiography: A Pilot Study.

Kwon, Boseong / Lee, Ki Baek / Yoon, Jong-Tae / Choi, Joon Ho / Lee, Deok Hee / Song, Yunsun

Neurointervention

2022 Volume 17, Issue 3, Page(s) 143–151

Abstract: Purpose: The purpose of this study was to evaluate the safety and effectiveness of a new angiographic system (Catheter 3.0 system) using a 5 French (Fr), large-bore angiography catheter, a 0.032-inch stiff guidewire, and a continuous flushing system in ... ...

Abstract	Purpose: The purpose of this study was to evaluate the safety and effectiveness of a new angiographic system (Catheter 3.0 system) using a 5 French (Fr), large-bore angiography catheter, a 0.032-inch stiff guidewire, and a continuous flushing system in diagnostic cerebral angiography. Materials and methods: This retrospective study included 30 consecutive patients who underwent transfemoral cerebral angiography using the Catheter 3.0 system from October 2019 to March 2020. As the control group, we included 30 consecutive patients examined before the Catheter 3.0 system was introduced. Procedural outcomes, including technical success, procedure time, dose metrics, procedure-related complications, and image quality were reviewed and analyzed. Results: All transfemoral cerebral angiographies were performed for a diagnosis of unruptured intracranial aneurysms. The Catheter 3.0 system showed a significantly shorter fluoroscopy time (6.2 vs. 9.7 minutes, P=0.008) and lower fluoroscopy dose (387.2 vs. 614.4, P=0.002) compared with the conventional 4-Fr catheter system. The Catheter 3.0 system also showed better results in terms of procedural time (21.0 vs. 22.5 minutes, P=0.072) and technical success rate (98.1% vs. 94.0%, P=0.078), although a statistical significance was not reached. The complication rate and qualitative assessment of the digital subtraction angiography (DSA) image quality were similar between the two groups. Conclusion: The Catheter 3.0 system using a 5 Fr catheter with a large inner diameter was convenient, effective, and safe compared with the conventional system in diagnostic cerebrovascular angiography.
Language	English
Publishing date	2022-07-28
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2639823-0
ISSN	2233-6273 ; 2093-9043
ISSN (online)	2233-6273
ISSN	2093-9043
DOI	10.5469/neuroint.2022.00248
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