Journal of Yeungnam Medical Science

Original articles

Cardiology and Cardiovascular Medicine
Association between clopidogrel preloading time and post-procedural troponin elevation in patients with stable angina undergoing elective percutaneous coronary intervention: a retrospective cohort study: Sungho Jo, Jeong Tae Byoun, Donghyeon Joo, Jae Young Cho, Kyeong Ho Yun; J Yeungnam Med Sci. 2026;43:34. Published online May 18, 2026; DOI: https://doi.org/10.12701/jyms.2026.43.34

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Abstract PDF: Background
Clopidogrel requires several hours to achieve adequate platelet inhibition. We investigated the association of clopidogrel preloading time with 30-day clinical outcomes and post-procedural troponin elevation in patients with stable angina undergoing elective percutaneous coronary intervention (PCI).
Methods
This single-center retrospective cohort study included 1,020 patients with stable angina (clopidogrel-naive) who received 300 mg clopidogrel preloading within 24 hours before elective PCI between 2012 and 2020. Patients were categorized according to clopidogrel preloading-to-balloon time ≤6 hours or >6 hours. The primary endpoint was 30-day major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, stroke, and any revascularization. Secondary endpoints included serial troponin T changes and troponin T elevation ≥5×, ≥25×, and ≥70× the upper reference limit. Stabilized inverse probability of treatment weighting (IPTW) was used.
Results
Thirty-day MACE occurred in five patients (0.49%) and did not differ between the ≤6-hour and >6-hour groups after IPTW (0.5% vs. 0.4%, p=0.754). Post-procedural troponin T levels at 6, 24, and 48 hours were higher in the ≤6-hour group. Patients with shorter preloading-to-balloon times showed higher peak troponin T levels, with the greatest difference at the ≤1-hour cutoff (geometric mean ratio, 2.12; 95% confidence interval, 1.53–2.95; p<0.001) and progressive attenuation at longer cutoffs. Troponin T elevation ≥5× and ≥25× was more frequent in the ≤6-hour group, whereas ≥70× elevation did not differ.
Conclusion
Clopidogrel preloading ≤6 hours before elective PCI was not associated with increased 30-day MACE but was associated with lower-threshold post-procedural troponin T elevation.

Cardiology and Cardiovascular Medicine
The performance of ASpirin-FREE therapy after successful percutaneous coronary intervention for acute coronary syndrome: the ASFREE prospective pilot study: Donghyeon Joo, Sungho Jo, Jeong Tae Byoun, Jae Young Cho, Kyeong Ho Yun; J Yeungnam Med Sci. 2026;43:25. Published online March 19, 2026; DOI: https://doi.org/10.12701/jyms.2026.43.25

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Abstract PDF: Background
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS); however, bleeding risk remains a major concern. Early discontinuation of aspirin due to potent P2Y12 inhibition may mitigate bleeding without increasing thrombotic events.
Methods
The ASpirin-FREE therapy after successful percutaneous coronary intervention for acute coronary syndrome (ASFREE) study was an investigator-initiated, single-center, prospective, open-label, single-arm pilot study enrolling patients with ACS who underwent PCI with drug-eluting stents. All patients received a single loading dose of aspirin on the day of the PCI, followed by ticagrelor or prasugrel monotherapy. The primary efficacy endpoint was target vessel failure (TVF) at 12 months. The primary safety endpoint was definite stent thrombosis. Event rates are reported with 95% confidence intervals (CIs).
Results
In total, 228 patients were enrolled. TVF occurred in 10 patients (4.4%; 95% CI, 2.1%–7.9%). Definite stent thrombosis was observed in one patient (0.4%; 95% CI, 0.01%–2.4%), with no acute or subacute events. Major bleeding (Bleeding Academic Research Consortium type 3 or 5) occurred in two patients (0.9%; 95% CI, 0.1%–3.1%).
Conclusion
An aspirin-free strategy following a single loading dose with continuation of potent P2Y12 inhibitor monotherapy was feasible in patients with ACS undergoing PCI and was associated with low rates of thrombotic and major bleeding events. These findings should be regarded as hypothesis-generating and supporting further evaluations in adequately powered randomized controlled trials (CRIS registration: KCT0008182).

Case report

Cardiology and Cardiovascular Medicine
Fatal progressive right heart failure in a pancreatic cancer patient: Jeong Tae Byoun, Jae Young Cho; Yeungnam Univ J Med. 2020;37(2):122-127. Published online September 19, 2019; DOI: https://doi.org/10.12701/yujm.2019.00332

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Abstract PDF

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but fatal complication of cancer and causes pulmonary hypertension and acute/subacute right heart failure. PTTM is most commonly associated with gastric cancer and more rarely associated with pancreatic cancer. We report a case of progressive right heart failure associated with clinically diagnosed pancreatic cancer, suggesting PTTM.

Citations

Citations to this article as recorded by

Multi-omics analysis of genetic drivers linking aortic stenosis and left ventricular diastolic dysfunction in heart failure
Zeeshan Ahmed, Prithvi Govindareddy, Jayden Mathew, Naveena Yanamala, Partho P. Sengupta
BioData Mining.2026;[Epub] CrossRef
A rare, life-threatening debut of pancreatic adenocarcinoma: Pulmonary tumor thrombotic microangiopathy
Pablo Jiménez-Labaig, Soledad Fernández Solé, Susana Gómez Varela, Jorge García Calvo, Sergio Carrera Revilla, Alberto Muñoz Llarena
Current Problems in Cancer: Case Reports.2023; 10: 100238. CrossRef
Evidence of sex differences in cancer‐related cardiac complications in mouse models of pancreatic and liver cancer
Anna Gams, Alejandro Nevarez, Stephanie Perkail, Aileen Venegas, Sharon A. George, Tatiana Efimova, Igor R. Efimov
Physiological Reports.2023;[Epub] CrossRef
Prospective of Pancreatic Cancer Diagnosis Using Cardiac Sensing
Mansunderbir Singh, Priyanka Anvekar, Bhavana Baraskar, Namratha Pallipamu, Srikanth Gadam, Akhila Sai Sree Cherukuri, Devanshi N. Damani, Kanchan Kulkarni, Shivaram P. Arunachalam
Journal of Imaging.2023; 9(8): 149. CrossRef
Fatal pulmonary tumour thrombotic microangiopathy in patient with ovarian adenocarcinoma: review and a case report
Gintare Neverauskaite-Piliponiene, Kristijonas Cesas, Darius Pranys, Skaidrius Miliauskas, Lina Padervinskiene, Jolanta Laukaitiene, Giedre Baksyte, Gintare Sakalyte, Egle Ereminiene
BMC Cardiovascular Disorders.2022;[Epub] CrossRef

Original articles

Neurosurgery
Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms: Jae Young Choi, Chang Hwa Choi, Jun Kyeung Ko, Jae Il Lee, Chae Wook Huh, Tae Hong Lee; Yeungnam Univ J Med. 2019;36(3):208-218. Published online April 25, 2019; DOI: https://doi.org/10.12701/yujm.2019.00192

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Abstract PDF

Background
The anatomy of middle cerebral artery (MCA) aneurysms has been noted to be unfavorable for endovascular treatment. The purpose of this study was to assess the feasibility and efficacy of coiling for MCA aneurysms.
Methods
From January 2004 to December 2015, 72 MCA aneurysms (38 unruptured and 34 ruptured) in 67 patients were treated with coils. Treatment-related complications, clinical outcomes, and immediate and follow-up angiographic outcomes were retrospectively analyzed.
Results
Aneurysms were located at the MCA bifurcation (n=60), 1st segment (M1, n=8), and 2nd segment (M2, n=4). Sixty-nine aneurysms (95.8%) were treated by neck remodeling techniques using multi-catheter (n=44), balloon (n=14), stent (n=8), or combination of these (n=3). Only three aneurysms were treated by single-catheter technique. Angiographic results were 66 (91.7%) complete, five (6.9%) remnant neck, and one (1.4%) incomplete occlusion. Procedural complications included aneurysm rupture (n=1), asymptomatic coil migration to the distal vessel (n=1), and acute thromboembolism (n=10) consisting of eight asymptomatic and two symptomatic events. Treatment-related permanent morbidity and mortality rates were 4.5% and 3.0%, respectively. There was no bleeding on clinical follow-up (mean, 29 months; range, 6-108 months). Follow-up angiographic results (mean, 26 months; range, 6-96 months) in patients included one major and three minor recanalizations.
Conclusion
Coiling of MCA aneurysms could be a technically feasible and clinically effective treatment strategy with acceptable angiographic and clinical outcomes. However, the safety and efficacy of this technique as compared to surgical clipping remains to be ascertained.

Citations

Citations to this article as recorded by

Efficacy and safety of endovascular interventions for unruptured middle cerebral artery aneurysms: a systematic review and meta-analysis of occlusion rates and periprocedural complications
Glenn O. Taryana, Asra A. Fauzi, Muhammad Miftahussurur, Nur S. Suroto
Journal of Clinical Neuroscience.2025; 139: 111380. CrossRef
Adverse events during endovascular treatment of ruptured aneurysms: A prospective nationwide study on subarachnoid hemorrhage in Sweden
Bryndís Baldvinsdóttir, Paula Klurfan, Johanna Eneling, Elisabeth Ronne-Engström, Per Enblad, Peter Lindvall, Helena Aineskog, Steen Friðriksson, Mikael Svensson, Peter Alpkvist, Jan Hillman, Erik Kronvall, Ola G. Nilsson
Brain and Spine.2023; 3: 102708. CrossRef
Microsurgical Clipping versus Advanced Endovascular Treatment of Unruptured Middle Cerebral Artery Bifurcation Aneurysms After a “Coil-First” Policy
Muriel Pflaeging, Christoph Kabbasch, Marc Schlamann, Lenhard Pennig, Stephanie Theresa Juenger, Jan-Peter Grunz, Marco Timmer, Gerrit Brinker, Roland Goldbrunner, Boris Krischek, Lukas Goertz
World Neurosurgery.2021; 149: e336. CrossRef

Urology
Comparison of three different endoscopic approaches in the treatment of bladder calculi: Jae Youn Jang, Young Hwii Ko, Phil Hyun Song, Jae Young Choi; Yeungnam Univ J Med. 2019;36(1):16-19. Published online December 19, 2018; DOI: https://doi.org/10.12701/yujm.2019.00045

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4 Crossref

Abstract PDF

Background
This study compared the following three endoscopic techniques used to treat bladder stones: transurethral cystoscope used with a pneumatic lithoclast or nephroscope used with a pneumatic lithoclast and nephroscope used with an ultrasonic lithoclast.
Methods
Between January 2013 and May 2016, 107 patients with bladder stones underwent endoscopic treatment. Patients were classified into 3 groups based on the endoscopic techniques and energy modalities used in each group as: group 1 (transurethral stone removal using a cystoscope with pneumatic lithoclast), group 2 (transurethral stone removal using a nephroscope with pneumatic lithoclast), and group 3 (transurethral stone removal using a nephroscope with ultrasonic lithoclast). Baseline and perioperative data were retrospectively compared between three groups.
Results
No statistically significant intergroup differences were observed in age, sex ratio, and stone size. A statistically significant intergroup difference was observed in the operation time—group 1: 71.3±46.6 min; group 2: 33.0±13.7 min; and group 3: 24.6±8.0 min. All patients showed complete stone clearance. The number of urethral entries was higher in group 1 than in the other groups. Significant complications did not occur in any patient.
Conclusion
Nephroscopy scores over cystoscopy for the removal of bladder stones with respect to operation time. Ultrasonic lithoclast is a safe and efficacious modality that scores over a pneumatic lithoclast with respect to the operation time.

Citations

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Emerging Role of Laser Lithotripsy for Bladder Stones: Real-World Outcomes from Two European Endourology Centers with a Systematic Review of Literature
Clara Cerrato, Maria Florencia Frascheri, Shriya Napoleon Fernandez, Esteban Emiliani, Paola Arena, Amelia Pietropaolo, Bhaskar K. Somani
Journal of Endourology.2025; 39(3): 285. CrossRef
Endoscopic Management of Large Vesical Calculus

Pakistan Journal of Medicine and Dentistry.2025;[Epub] CrossRef
Mechanical Lithotriptor: A Modern Perspective on an Undervalued Tool
Halil İbrahim İvelik, Okan Alkış, Mehmet Sevim, İbrahim Kartal, Şeref Coşer, Hüseyin Özgür Kazan, Bekir Aras
Endouroloji Bulteni.2025; 17(1): 1. CrossRef
Comparison of nephroscopy and cystoscopy used in the treatment of bladder stones: a systematic review and meta-analysis of randomized controlled trials
Liping Gou, Zhenghao Wang, Ye Zhou, Xiaofeng Zheng
BMC Surgery.2021;[Epub] CrossRef

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