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Journal of Korean Neurosurgical Society > Volume 62(5); 2019 > Article
Kim, Kwon, Shin, Sung, Koh, and Kim: Endovascular Treatments Performed Collaboratively by the Society of Korean Endovascular Neurosurgeons Members : A Nationwide Multicenter Survey

Abstract

Objective

Since less invasive endovascular treatment was introduced to South Korea in 1994, a considerable proportion of endovascular treatments have been performed by neuroradiology doctors, and endovascular treatments by vascular neurosurgeons have recently increased. However, few specific statistics are known regarding how many endovascular treatments are performed by neurosurgeons. Thus, authors compared endovascular treatments collaboratively performed by vascular neurosurgeons with all cases throughout South Korea from 2013 to 2017 to elucidate the role of neurosurgeons in the field of endovascular treatment in South Korea.

Methods

The Society of Korean Endovascular Neurosurgeons (SKEN) has issued annual reports every year since 2014. These reports cover statistics on endovascular treatments collaboratively or individually performed by SKEN members from 2013 to 2017. The data was requested and collected from vascular neurosurgeons in various hospitals. The study involved 77 hospitals in its first year, and 100 in its last. National statistics on endovascular treatment from all over South Korea were obtained from the Healthcare Bigdata Hub website of the Health Insurance Review & Assessment Service based on the Electronic Data Interchange (EDI) codes (in the case of intra-arterial (IA) thrombolysis, however, statistics were based on a combination of the EDI and I63 codes, a cerebral infarction disease code) from 2013 to 2017. These two data sets were directly compared and the ratios were obtained.

Results

Regionally, during the entire study period, endovascular treatments by SKEN members were most common in Gyeonggi-do, followed by Seoul and Busan. Among the endovascular treatments, conventional cerebral angiography was the most common, followed by cerebral aneurysmal coiling, endovascular treatments for ischemic stroke, and finally endovascular treatments for vascular malformation and tumor embolization. The number of endovascular treatments performed by SKEN members increased every year.

Conclusion

The SKEN members have been responsible for the major role of endovascular treatments in South Korea for the recent 5 years. This was achieved through the perseverance of senior members who started out in the midst of hardship, the establishment of standards for the training/certification of endovascular neurosurgery, and the enthusiasm of current SKEN members who followed. To provide better treatment to patients, we will have to make further progress in SKEN.

INTRODUCTION

We live in an era of many medical upheavals. For instance, the development of technology and medical knowledge due to material engineering and basic sciences have led to rapid advances in medical equipment. In addition, rapid changes in national medical policies, such as introduction of telemedicine, abolition of uncovered health services or the reduced workload for residents as 80-hour per week, have changed the medical environment [16]. Vascular neurosurgeons must adapt to these changes to stay current. Recently, vascular neurosurgery has become more popular, even though it is perceived as 3D-jobs in the neurosurgical field, because vascular neurosurgeons have begun to perform less invasive endovascular treatment as well as the traditional open surgical treatments. In fact, younger vascular neurosurgeons view endovascular treatment as a necessity, not an option, and so-called “hybrid” vascular neurosurgeons who can perform both craniotomies and endovascular surgery are taken for granted. Relatedly, the residents’ training regulations of the Korean Neurosurgical Society have been changed to allow more endovascular treatment in training programs.
Although, a considerable proportion of endovascular treatment in South Korea since 1994 has been carried out by neuroradiology doctors, endovascular treatment performed by vascular neurosurgeons had been increased gradually, and they have increased much more since the establishment of standards for the training and certification of endovascular neurosurgery in South Korea has been firstly published [17]. However, few specific statistics are known regarding how many endovascular treatments are performed by neurosurgeons, so the role of neurosurgeons in this field is unclear. For this reason, the annual reports of the Society of Korean Endovascular Neurosurgeons (SKEN) from 2013 to 2017 have included a statistical report on endovascular treatment performed by or with the participation of vascular neurosurgeons. In the present study, authors compared endovascular treatment cases by vascular neurosurgeons of the SKEN annual reports with data obtained from the nationwide Health Insurance Review and Assessment Service (HIRA) of South Korea from 2013 to 2017. In this way, authors ascertained the pattern of endovascular treatment in South Korea and examined the role of vascular neurosurgeons in the field of endovascular treatment in South Korea.

MATERIALS AND METHODS

Data collection and period in annual report of SKEN from 2013 to 2017

The SKEN has been issuing annual reports since 2014; these include statistics on all endovascular treatments performed alone or collaboratively with another clinician, such as a neuroradiologist, by SKEN members between 2013 and 2017. These data were collected using a data sheet that recorded the number of endovascular treatments performed in each year. Firstly, the editorial director of the annual report notified each hospital via e-mail. The hospitals then sent data via e-mail using the data sheet (Fig. 1). The data were also requested and collected from vascular neurosurgeons of various hospitals, including certified institutions of the SKEN via one-on-one telephone calls and text messages by the editorial director. This data collection was carried out over about 3 months each year from 2014 to 2018. The number of hospitals involved ranged from 77 to 100, and the number of endovascular treatments was assumed to be the number of patients, except in the case of aneurysms, whereby the number of aneurysm itself was recorded. In this regard, the report differed from the HIRA, in which the number of patients with aneurysm was counted. This was taken into account during data analysis. The present study analyzed these clinical data from annual SKEN report between 2013 and 2017.

Data collection and period from the Healthcare Bigdata Hub of HIRA

National statistics on endovascular treatment in South Korea were obtained from the Healthcare Bigdata Hub website of the HIRA. The target period for data collection was also 2013-2017. These data were collected in accordance with the Electronic Data Interchange (EDI) code, which was matched to the endovascular treatments on the data sheet distributed to SKEN members (Table 1). However, in the case of intra-arterial (IA) thrombolysis, data collection was based on a combination of the EDI and I63 codes, a cerebral infarction disease code, because the HIRA provided additional data on combining the EDI and I63 codes. We believe that the combined data are more accurate than data from the EDI code only.

Data analysis

This study was approved by the Institutional Review Board (IRB) of CHA Bundang Medical Center, CHA Univeristy School of Medicine on July 4th, 2019 as a deliberative exemption (IRB No. CHAMC 2019-06-035). Authors directly compared the data collected from SKEN with the nationwide data from the Healthcare Bigdata Hub of the HIRA. However, the category of extracranial percutaneous transluminal angioplasty or stent including carotid artery stenting (“EC-PTA or stent [CAS]”) and EC-PTA or stent excluding carotid artery stenting (“EC-PTA or stent [the rest of CAS]”) in the data collected from SKEN were combined into “EC-PTA or stent (including CAS)” and compared to the “EC-PTA or stent (including CAS)” in HIRA’s data. Authors also obtained the ratio between the data collected from SKEN and the nationwide data. Using these data, authors analyzed the flow and trends of endovascular treatments performed in South Korea from 2013 to 2017.

RESULTS

Endovascular treatments performed collaboratively by vascular neurosurgeons from 2013 to 2017

In the years 2013 to 2017, 77, 82, 85, 93, and 100 hospitals participated in the survey, respectively. The data for each hospital were analyzed by region and category, and the overall data were analyzed according to each category (Table 2). Regionally, in all the years analyzed, endovascular treatments were most common in Gyeonggi-do, followed by Seoul and Busan (Fig. 2). With regards to specific endovascular treatments, conventional cerebral angiography was the most common (that is digital subtraction angiography; “DSA”), followed by cerebral aneurysmal coiling and treatments for ischemic stroke, vascular malformation, and tumor embolization (Fig. 3).
The number of hospitals participating in data collection gradually increased during the study period, as did the number of endovascular treatments performed collaboratively by SKEN members. However, the increase in the number of endovascular treatments was greater than the increase in the number of participating hospitals. Specifically, the rate of increase in each category was higher than the rate of increase in the number of participating hospitals (from 77 to 100; 29.9%), with the exception of “EC-PTA or stent (the rest of CAS)”, which increased from 194 to 226 patients (16.5%), and treatment for arteriovenous malformation (“AVM”), which increased from 177 to 221 patients (24.9%) (Table 2). The rates of increase exceeded 50% in “DSA”, simple coilings (“coiling”), stent- or balloon-assisted coilings (“stent or balloon”), “IA thrombolysis for cerebral infarction”, “EC-PTA or stent (CAS)”, “intracranial (IC)-PTA or stent” and dural arteriovenous fistula or carotid- cavernous fistula (“dural AVF or CCF”), especially in the case of “IA thrombolysis for cerebral infarction”, which showed an increase of more than 200% (Table 2). The increase in the number of unruptured intracranial aneurysms (“UIA”, from 3303 to 5563; 68.4%) was higher than the increase in the number of ruptured aneurysms (“Ruptured”, from 1999 to 2838; 42%).

Nationwide data from the Healthcare Bigdata Hub of the HIRA from 2013 to 2017

Nationwide data from the HIRA between 2013 and 2017 were analyzed by region and category, and the overall data were analyzed according to each category (Tables 3-8). Regionally, endovascular treatment was the most common in Seoul, followed by Gyeonggi-do and Busan in all years analyzed. Concerning specific endovascular treatments, “DSA” was the most common, followed by cerebral aneurysmal coiling and treatments for ischemic stroke, vascular malformation, and tumor embolization.
Additionally, national data showed an overall increase in the number of endovascular treatments during the study period, and the rates of increase exceeded 50% in “DSA”, aneurysm (“coiling + parent artery occlusion [“PAO”]” and “stent or balloon”), and “IA thrombolysis for cerebral infarction”; “IA thrombolysis for cerebral infarction” showed an increase of more than 200% (Table 3). The rates of increase were about 40% in “dural AVF or CCF” and “tumor embolization”, about 30% in “EC-PTA or stent (including CAS)” and intracranial percutaneous transluminal angioplasty or stent (“IC-PTA or stent”), and about 15% in “AVM”.

Comparison between data collected from SKEN members and nationwide data from the Healthcare Bigdata Hub of the HIRA from 2013 to 2017

During the 5 years from 2013 to 2017, SKEN members participated in 50-55% of “DSA”, 70-80% of “IA thrombolysis for cerebral infarction”, 50-70% of “EC-PTA or stent (including CAS)”, 65-85% of “IC-PTA or stent”, 60-75% of “AVM”, 75-95% of “dural AVF or CCF”, 40-60% of “tumor embolization” (Tables 3-8; Fig. 4). Although the overall number of endovascular treatments performed by SKEN members increased during the study period, there were no significant changes in the categories “DSA”, “IA thrombolysis for cerebral infarction”, “AVM”, “dural AVF or CCF”, and “tumor embolization” with regard to the ratio of data from SKEN members to those from HIRA. An increase in the ratio was observed for “EC-PTA or stent (including CAS)” and “IC-PTA or stent” (Tables 3-8). In the category of aneurysm treatments, SKEN members participated in approximately 100-108% of “coiling” and about 60-65% of “stent or balloon” (Tables 3-8). Because the number of aneurysmal treatments involving SKEN members was counted as the number of aneurysms, while the number of aneurysmal treatments in the HIRA was counted as the number of patients, authors could not directly compare the two data sets, so the derived ratios cannot be meaningful (100-108% and 60-65%). During the 5-year study period, there were no significant changes in the ratio of aneurysmal data between SKEN members and the HIRA (Tables 3-8).
In summary, the ratio of data from SKEN members to that from HIRA was about 50-70% for “DSA”, aneurysm (“coiling + PAO” and “stent or balloon”), and “AVM”, 70-90% for “IA thrombolysis for cerebral infarction” and “dural AVF or CCF”, and 45-60% for “tumor embolization”; these ratios did not change much over the 5-year study period. For “EC-PTA or stent (including CAS)” and “IC-PTA or stent”, the ratios were 50-70% and 65-85%, respectively, and the increasing trend was significant.

DISCUSSION

Clinical and autopsy studies suggest that intracranial aneurysms have a frequency of 1-8% [9], and that the incidence of subarachnoid hemorrhage due to ruptured aneurysms ranges from 6 to 8 people per 100,000 in western populations [5]. In the 1960s, McKissock et al. [6-8] were the first to report some controlled trials into the conservative and surgical treatment of ruptured aneurysms. They showed better outcomes using surgical management [6-8]. Since then, surgical techniques, instruments, and management methods have developed greatly, resulting in better outcomes. In 1991, electrolytically detachable coils (Guglielmi detachable coils; Boston scientific/Target Therapeutics, Freemont, CA, USA) were introduced to treat ruptured aneurysms using an endovascular approach. They were approved by United States Food and Drugs Administration (FDA) in 1995 [4]. Since then, endovascular coiling has widely been used to treat ruptured and unruptured aneurysms [1,2,15]. In particular, the serial trial known as the International Subarachnoid Aneurysm Trial, which was carried out from 2002 to 2015, proved the efficacy and safety of endovascular coiling methods [11-14]. With these successful trials, endovascular coiling could be recommended in the 2012 guidelines as a first option to treat patients with ruptured aneurysms judged to be technically amenable to both endovascular coiling and neurosurgical clipping [3]. In unruptured aneurysms, endovascular coiling is associated with lower procedural morbidity and mortality than surgical clipping in selected cases, and it is recommended at Class IIa with Level of Evidence B [18].
In South Korea, endovascular treatment research meetings began in 1994. In particular, two meetings were started by neurosurgeons and neuroradiologists, respectively. Each meeting then developed into a society : the SKEN, as well as the Korean Society of Interventional Neuroradiology (KSIN). At first, endovascular treatments were mainly performed by neuroradiologists. However, many vascular neurosurgeons eventually became interested and involved in endovascular treatment. Recently, endovascular treatment has been performed by neurosurgeons, neuroradiology doctors, or both, and the specific situations vary among hospitals.
According to data collected from SKEN members over 5 years from 2013 to 2017, the number of endovascular treatments performed collaboratively by SKEN members continuously increased over the period. Big cities such as Gyeonggi-do, Seoul, and Busan led this, but the phenomenon was observed nationwide. Among the endovascular treatments, conventional cerebral angiography was the most common, followed by cerebral aneurysmal coiling, endovascular treatments for ischemic stroke, and finally endovascular treatments for vascular malformation and tumor embolization. With the number of hospitals participating in data collection increasing year by year, it was natural that the total number of endovascular treatments performed would increase (Fig. 3). However, the rate of increase in endovascular treatments was higher than that participating hospitals; even when each category was analyzed separately, the rate of increase was higher in all categories of endovascular treatment than in the number of participating hospitals, except for the categories of “EC-PTA or stent(the rest of CAS)”, and “AVM” (Table 2). In several categories, the rate showed an increase of more than 50%, and in the “IA thrombolysis for cerebral infarction” category it showed an increase of more than 200% (Table 3). This shows that the number of endovascular treatments performed by SKEN members has increased, although this may have been due to the increase in hospital participation in some cases.
According to data collected from SKEN members, the “EC-PTA or stent(the rest of CAS)” category likely showed a lower rate of increase because this category lies outside the traditional remit of neurosurgery, and the absolute case number of such procedures was small. Authors expect that there will be little future change in this category of “EC-PTA or stent”. In the category of “AVM”, it is likely that trial known as “A Randomized trial of Unruptured Brain Arteriovenous Malformations” (ARUBA) released in 2014 was the cause of the lower rate of increase. In the ARUBA trial, medical management alone was superior to medical management with interventional therapy in the prevention of death or stroke in patients with unruptured brain AVMs [10]. Therefore, endovascular treatment for unruptured AVM was probably reduced. Unless other studies contradict the results of the ARUBA trail, there may be no change in the rate of increase in the “AVM” category. In the category of aneurysms, there was a higher rate of increase in the number of unruptured aneurysm than in the number of ruptured aneurysms, perhaps because diagnostic tools such as brain computed tomography angiography or magnetic resonance angiography have been developed, or because health screening has been applied nationwide.
According to national data from HIRA from 2013 to 2017, the number of endovascular treatments continuously increased over the 5-year period and were the highest in Seoul, followed by Gyeonggi-do and Busan, which is slightly different from the trend for SKEN data, according to which endovascular treatments were most common in Gyeonggi-do (Tables 3-8). During the study period, the rate of increase in endovascular treatments exceeded 50% in “DSA”, aneurysm (“coiling + PAO” and “stent or balloon”) and “IA thrombolysis for cerebral infarction”, was about 40% in “dural AVF or CCF” and “tumor embolization”, and was about 15% in “AVM”, which were similar to the results from SKEN data (Table 3). In contrast, the rate of increase was about 30% in “EC-PTA or stent (including CAS)” and “IC-PTA or stent”, which was different from the results from SKEN data, according to which the rate of increase was about 70% (Table 3). These results are consistent with the following analysis from a different point of view. Compared with the national data collected from HIRA, there were no significant changes in the ratio of data from SKEN members to data from HIRA in “DSA”, aneurysm (“coiling + PAO” and “stent or balloon”), “IA thrombolysis for cerebral infarction”, “AVM”, “dural AVF or CCF” and “tumor embolization”, however, an increase in the ratio was noted for “EC-PTA or stent (including CAS)” and “IC-PTA or stent” (Table 3).
The categories of “DSA” and aneurysm (“coiling” + “PAO” and “stent or balloon”) showed a 50-60% ratio for data from SKEN members and from HIRA and “IA thrombolysis for cerebral infarction” showed a 70-80% ratio, which did not change significantly and the rates of increase exceeded 50% during the 5-year study period (Table 3). The reasons might be as follows. Diseases belonging to these categories are representative ones that require endovascular treatment and are quite common, so many of these categories have already been performed by vascular neurosurgeons since 2013. Therefore, this ratio is expected to proceed in a similar trend into the future. And in the category of aneurysmal treatments, the ratio in “coiling” was more than 100%, while in the “stent or balloon” it was 60-65%. The number of aneurysmal treatments involving SKEN members was counted as the number of aneurysms, while the number in the HIRA was counted as the number of patients. Therefore, it was not possible to directly compare the two data sets. However, assuming that multiple aneurysms occur in 25% of cases, SKEN members likely participated in the treatment of more than 50% of aneurysms. In addition, even though the ratio itself was meaningless, there were no significant changes in the ratio of aneurysmal data between SKEN members and the HIRA over the 5-year study period, which may indicate that the data collected by the SKEN were quite reliable. In the category of “IA thrombolysis for cerebral infarction”, the rates of increase was above 200%, which was from that the treatment performance improved greatly due to the rapid development of treatment technology in recent years (Table 3). Therefore, the ratio of data from SKEN members to those from HIRA will be similar, but the total number will continue to increase.
“AVM” showed a 60-75% ratio, which did not change significantly during the study period. The rate of increase was about 15-25% during the study period, which was assumed to remain unchanged per the ARUBA trial, as mentioned above. The categories “dural AVF or CCF” and “tumor embolization” showed 75-95% and 40-60% ratios, which did not change significantly over the 5-year study period. The rate of increase was about 40-50% and 36-40%, respectively. Although these categories are not common, they are likely of interest to vascular neurosurgeons. The categories “EC-PTA or stent (including CAS)” and “IC-PTA or stent” showed 50- 70% and 65-85% ratios, respectively, and the difference in the rate of increase between SKEN members and HIRA was found to be 30-70%. These ratios seem to change from conventional surgical (in the case of “EC-PTA or stent [including CAS])” or medical (in the case of “IC-PTA or stent”) treatment to endovascular treatment, possibly led by vascular neurosurgeons (SKEN members).
In 1997, Veith [19], the President of the Society for Vascular Surgery, delivered the Presidential address in celebration of the 50th anniversary of the foundation of the Society. In that speech, he mentioned the threats to the specialized field of vascular surgery, emphasizing that advances in technology have allowed less-invasive, more cost-effective treatments, and that fiscal policy has encouraged it. This has increased the possibility that vascular surgery will become extinct. The less-invasive treatments of vascular disease he mentioned were endovascular treatments such as catheter-guidewire-imaging techniques involving catheters, balloons, atherectomy devices, stents, stented grafts, etc. He thought these were threats to the vascular surgeons because they confer similar or better results to open surgical treatments, and because they can be performed by non-surgical interventional specialists with training in radiology or cardiology [19]. For this reason, he argued that vascular surgeons must learn and practice endovascular treatment skills, and that, if they do not, they will be culled.
This was the situation in the US vascular surgery (not vascular neurosurgery) around 1997, and it is surprisingly similar to the situation of vascular neurosurgery in South Korea since 1994. At that time, endovascular treatment began in South Korea, but no one could be sure about the potential of the treatment for development. Fortunately, our forerunners had foresight and tried to adapt to these changes in the environment. Since 1994, they have established a research meeting and developed it into a society (SKEN) to continue and expand the role of vascular neurosurgeons. Of course, this development process produced many difficulties. While conventional open surgery was already established, endovascular treatment was a field in which results had to be made: there were many trials and errors, and it was difficult to be recognized by the Korean Neurosurgical Society. Furthermore, there were many conflicts with neuroradiologists, who had already taken an important positions in the field of endovascular treatment. Despite these difficulties, our forerunners did not stop their efforts. As the result, a substantial proportion of endovascular treatment in South Korea is now carried out by vascular neurosurgeons, as shown above. The SKEN, which has grown in quantity and quality, still makes such efforts and will continue to do so.

Limitations of the study

The data from the present study were collected from vascular neurosurgeons across the country over 5 years, with 77-100 hospitals involved (Table 9). However, this number does not include all hospitals with vascular neurosurgeons. In other words, the data in this study reflect only a subsection of all vascular neurosurgeons in South Korea. As mentioned earlier, aneurysm cases collected by the SKEN were based on the number of treated aneurysms, while the cases in the HIRA were based on the number of patients. Therefore, it was not possible to directly compare them. If comparisons were made using the same criteria, more accurate results could be obtained.

CONCLUSION

The SKEN members have been responsible for the major role of endovascular treatments in South Korea for the recent 5 years. This was achieved through the perseverance of senior members who started out in the midst of hardship, the establishment of standards for the training/certification of endovascular neurosurgery, and the enthusiasm of current SKEN members who followed. To provide better treatment to patients, we will have to make further progress in SKEN.

Notes

No potential conflict of interest relevant to this article was reported.

INFORMED CONSENT

This type of study does not require informed consent.

AUTHOR CONTRIBUTIONS

Conceptualization : BTK

Data curation : TGK, OKK, YSS, JHS, JSK, BTK

Formal analysis : TGK

Funding acquisition : TGK, BTK

Methodology : TGK, BTK

Project administration : BTK

Visualization : TGK

Writing - original draft : TGK

Writing - review & editing : BTK

Acknowledgements

This work was supported by the Bio Industrial Strategic Technology Development Program (20001234) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea) and Soonchunhyang University Research Fund.
Authors would like to express deep gratitude to the hospitals and SKEN members who responded to the survey.

Fig. 1.
Required statistical data sheet delivered to SKEN members. The number of aneurysmal treatments reported in this annual report was counted as the number of aneurysms, which is different from the number in the HIRA, which was counted by patient. SKEN : The Society of Korean Endovascular Neurosurgeons, HIRA : the Health Insurance Review & Assessment Service, DSA : digital subtraction angiography, PAO : parent artery occlusion, UIA : unruptured intracranial aneurysms, PTA : percutaneous transluminal angioplasty, CAS : carotid artery stenting, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous stula.
jkns-2018-0216f1.jpg
Fig. 2.
Graphical data from the SKEN members according to region and category in 2017. Endovascular treatments were the most common in Gyeonggi-do, followed by Seoul and Busan. This trend was also observed in all periods from 2013 to 2017. SKEN : The Society of Korean Endovascular Neurosurgeons.
jkns-2018-0216f2.jpg
Fig. 3.
Serial data from SKEN members according to each category. With the exception of digital subtraction angiography (DSA), cerebral aneurysmal coiling was the most common, endovascular treatments for ischemic stroke were second, followed by endovascular treatments for vascular malformation and tumor embolization. SKEN : The Society of Korean Endovascular Neurosurgeons.
jkns-2018-0216f3.jpg
Fig. 4.
Comparison between data collected from SKEN members and nationwide data from the Healthcare Bigdata Hub of the HIRA from 2013 to 2017. SKEN : The Society of Korean Endovascular Neurosurgeons, HIRA : the Health Insurance Review & Assessment Service.
jkns-2018-0216f4.jpg
Table 1.
Endovascular treatments and EDI codes matched
Endovascular treatments EDI code
DSA HA 601, HA602, HA603, HA604, HA605, HA606, HA691, HA692, HA693, HA694
Coiling M1662
Stent or balloon assisted coiling M1661
IA thrombolysis for cerebral infarction* M6630, M6631, M6633, M6636 + I63
Extracranial PTA or Stent M6602, M6594
Intracranial PTA or Stent M6601, M6593
AVM embolization M1663, M1667, M1668, M1669
Dural AVF or CCF embolization M1664, M1665, M1666
Tumor embolization M1673, M1674, M1675

* Exceptionally, in the case of IA thrombolysis, it was based by combining EDI code and I63, a cerebral infarction disease code.

EDI : Electronic Data Interchange, DSA : digital subtraction angiography, IA : intra-arterial, PTA : percutaneous transluminal angioplasty, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous fistula

Table 2.
Data from SKEN members according to category from 2013 to 2017
Year The number of participating hospitals DSA Cerebral aneurysm
Ischemic stroke
Vascular malformation
Tumor embolization
Coiling PAO Stent or balloon Sub total* UIA Ruptured Sub total IA thrombolysis for cerebral infarction EC PTA or stent (CAS) EC PTA or stent (the rest of CAS) IC PTA or stent AVM Dural AVF or CCF
2013 77 25889 3275 83 1944 5302 3303 1999 5302 1179 1197 0 422 177 184 295
2014 82 28354 3577 77 2211 5865 3595 2270 5865 1570 1378 194 466 226 170 258
2015 85 33537 4022 107 2481 6610 4233 2377 6610 1738 1425 300 540 246 243 349
2016 93 38860 4513 112 3104 7729 5030 2699 7729 2187 1598 240 532 249 305 427
2017 100 44596 4935 118 3348 8401 5563 2838 8401 2666 1820 226 719 221 276 401
Ratio of 2017/2013 129.9 172.3 150.7 142.2 172.2 158.4 168.4 142.0 158.4 226.1 152 116.5 170.4 124.9 150 135.9

* The meaning of this 'subtotal' is the sum of the 'coiling', 'PAO' and 'Stent or balloon'.

The meaning of this 'subtotal' is the sum of the 'UIA' and 'Ruputred'.

Ratio of 2014 to 2017.

SKEN : The Society of Korean Endovascular Neurosurgeons, DSA : digital subtraction angiography, PAO : parent artery occlusion, UIA : unruptured intracranial aneurysms, IA : intra-arterial, ECPTA : extracranial percutaneous transluminal angioplasty, CAS : carotid artery stenting, ICPTA : intracranial percutaneous transluminal angioplasty, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous fistula

Table 3.
Comparison between data collected from SKEN members and nationwide data from the Healthcare Bigdata Hub of the HIRA from 2013 to 2017
Year DSA
Cerebral aneurysm
Ischemic stroke
Vascular malformation
Tumor embolization
Coiling+PAO
Stent or balloon
IA thrombolysis for cerebral infarction
EC PTA or stent (including CAS)
IC PTA or stent
AVM
Dural AVF or CCF
SKEN HA601-6, HA691-4 SKEN M1662 SKEN M1661 SKEN* M6630, 1,3,6 + I63 SKEN M6602, M6594 SKEN M6601, M6593 SKEN M1663, 7-9 SKEN M1664-6 SKEN M1673-5
2013 25889 (55.6%) 46541 3358 (101.5%) 3307 1944 (60.1%) 3236 1179 (72.8%) 1620 1197 (52.1%) 2297 422 (66.2%) 637 177 (60.8%) 291 184 (76.0%) 242 295 (47.9%) 616
2014 28354 (54.6%) 51975 3654 (98.6%) 3707 2211 (64.9%) 3409 1570 (83.5%) 1880 1572 (66.7%) 2358 466 (72.5%) 643 226 (61.4%) 368 170 (62.7%) 271 258 (41.5%) 622
2015 33537 (49.6%) 67651 4129 (102.0%) 4050 2481 (67.2%) 3691 1738 (69.0%) 2520 1725 (71.0%) 2431 540 (77.1%) 700 246 (70.7%) 348 243 (85.6%) 284 349 (52.8%) 661
2016 38860 (50.5%) 77024 4625 (105.9%) 4369 3104 (66.3%) 4684 2187 (75.1%) 2912 1838 (68.8%) 2672 532 (73.9%) 720 249 (73.9%) 337 305 (95.3%) 320 427 (59.1%) 722
2017 44596 (53.6%) 83268 5053 (108.5%) 4655 3348 (63.7%) 5258 2666 (77.5%) 3442 2046 (69.9%) 2929 719 (87.2%) 825 221 (66.2%) 334 276 (80.5%) 343 401 (45.7%) 878
Ratio of 2017/2013 172.3 178.9 150.5 140.8 172.2 162.5 226.1 212.5 170.9 127.5 170.4 129.5 124.9 114.8 150 141.7 135.9 142.5

* These data from SKEN members may include non-cerebral infarction cases, for example, when IA thrombectomy were performed for the thromboembolism that occurred during any endovascular procedures.

SKEN : The Society of Korean Endovascular Neurosurgeons, DSA : digital subtraction angiography, PAO : parent artery occlusion, IA : intra-arterial, EC : extracranial, PTA : percutaneous transluminal angioplasty, CAS : carotid artery stenting, IC : intracranial, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous fistula

Table 4.
Comparison between data collected from SKEN members and nationwide data from the Healthcare Bigdata Hub of the HIRA in 2013
Category DSA Cerebral aneurysm
Ischemic stroke
Vascular malformation
Tumor embolization

Coiling+PAO
Stent or balloon
IIA thrombolysis for cerebral infarction
EC PTA or stent (including CAS)
IC PTA or stent
AVM
Dural AVF or CCF

SKEN HA601-6, HA691-4 SKEN M1662 SKEN M1661 SKEN M6630, M6631, M6633, M6636 + I63 SKEN M6602, M6594 SKEN M6601, M6593 SKEN M1663, M1667, M1668, M1669 SKEN M1664, M1665, M1666 SKEN M1673, M1674, M1675
Seoul 3270 14448 774 1163 218 833 97 302 164 592 31 171 52 135 55 141 69 366
Busan 3843 4452 377 312 315 385 201 157 164 190 71 60 24 26 24 20 48 45
Incheon 2207 2048 171 156 71 64 83 57 72 85 41 24 9 9 7 0 13 12
Daegu 2922 3152 307 241 184 170 179 200 78 143 14 27 22 20 13 5 3 8
Gwangju 384 1491 91 85 57 56 9 117 26 87 10 38 5 7 3 6 0 0
Daejeon 1450 1927 205 193 122 159 91 81 50 136 31 36 8 9 1 1 1 3
Ulsan 724 791 133 13 69 167 36 26 18 24 8 5 2 3 7 4 2 3
Gyeonggi-do 5351 8463 605 497 446 671 152 213 235 440 70 117 32 44 49 41 133 143
Gangwon-do 660 959 78 62 64 59 54 53 66 85 19 21 4 4 7 4 6 4
Chungcheongbuk-do 974 1272 87 73 70 116 39 60 54 88 8 18 0 3 0 1 0 0
Chungcheongnam-do 509 1225 33 107 61 134 12 22 33 93 33 32 1 5 6 3 3 4
Jeollabuk-do 1264 1854 112 121 81 60 42 150 112 135 35 54 1 2 1 3 8 7
Jeollanam-do 0 109 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gyeongsangbuk-do 1571 2258 165 49 61 155 101 71 73 81 25 21 13 16 5 1 1 2
Gyeongsangnam-do 207 1570 170 186 89 180 61 91 31 97 0 6 1 6 5 11 6 17
Jeju-do 553 522 50 49 36 27 22 20 21 21 26 7 3 2 1 1 2 2
Total 25889 (55.6%) 46541 3358 (101.5%) 3307 1944 (60.1%) 3236 1179 (72.8%) 1620 1197 (52.1%) 2297 422 (66.2%) 637 177 (60.8%) 291 184 (76.0%) 242 295 (47.9%) 616

SKEN : The Society of Korean Endovascular Neurosurgeons, HIRA : the Health Insurance Review & Assessment Service, DSA : digital subtraction angiography, PAO : parent artery occlusion, IA : intra-arterial, EC : extracranial, PTA : percutaneous transluminal angioplasty, CAS : carotid artery stenting, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous fistula

Table 5.
Comparison between data collected from SKEN members and nationwide data from the Healthcare Bigdata Hub of the HIRA in 2014
Category DSA Cerebral aneurysm
Ischemic stroke
Vascular malformation
Tumor embolization

Coiling+PAO
Stent or balloon
IIA thrombolysis for cerebral infarction
EC PTA or stent (including CAS)
IC PTA or stent
AVM
Dural AVF or CCF

SKEN HA601-6, HA691-4 SKEN M1662 SKEN M1661 SKEN M6630, M6631, M6633, M6636 + I63 SKEN M6602, M6594 SKEN M6601, M6593 SKEN M1663, M1667, M1668, M1669 SKEN M1664, M1665, M1666 SKEN M1673, M1674, M1675
Seoul 3446 15556 733 1218 256 825 142 296 177 540 23 127 35 161 40 130 71 390
Busan 4082 5031 478 346 386 462 263 208 224 253 52 60 40 30 28 25 26 38
Incheon 1922 2276 203 186 70 74 113 64 60 64 42 21 16 16 8 5 6 7
Daegu 3117 3516 346 301 222 247 180 258 86 136 17 20 33 31 11 10 4 7
Gwangju 300 1556 68 60 82 77 20 106 20 74 3 33 2 3 0 9 0 0
Daejeon 1985 2227 337 277 150 151 102 95 127 165 38 35 16 15 12 11 18 18
Ulsan 756 933 75 33 33 120 34 31 10 19 10 7 9 11 4 7 3 7
Gyeonggi-do 6593 10150 658 582 548 771 222 314 368 462 156 157 49 57 46 54 111 128
Gangwon-do 764 1124 109 96 57 56 43 33 85 75 37 36 9 8 3 2 1 2
Chungcheongbuk-do 504 1005 58 50 37 98 23 45 28 53 1 12 0 4 0 0 0 2
Chungcheongnam-do 731 1430 119 116 127 172 33 29 75 109 15 23 5 13 8 4 3 4
Jeollabuk-do 1249 1798 112 133 96 40 136 161 146 165 33 40 1 2 3 5 8 10
Jeollanam-do 0 302 0 1 0 4 0 22 0 12 0 11 0 0 0 0 0 0
Gyeongsangbuk-do 2209 2843 182 75 58 139 112 80 96 92 31 27 5 7 3 1 2 1
Gyeongsangnam-do 356 1575 123 176 60 151 86 102 40 99 1 10 3 8 2 6 3 5
Jeju-do 340 653 53 57 29 22 61 36 30 40 7 24 3 2 2 2 2 3
Total 28354 (54.6%) 51975 3654 (98.6%) 3707 2211 (64.9%) 3409 1570 (83.5%) 1880 1572 (66.7%) 2358 466 (72.5%) 643 226 (61.4%) 368 170 (62.7%) 271 258 (41.5%) 622

SKEN : The Society of Korean Endovascular Neurosurgeons, HIRA : the Health Insurance Review & Assessment Service, DSA : digital subtraction angiography, PAO : parent artery occlusion, IA : intra-arterial, EC : extracranial, PTA : percutaneous transluminal angioplasty, CAS : carotid artery stenting, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous fistula

Table 6.
Comparison between data collected from SKEN members and nationwide data from the Healthcare Bigdata Hub of the HIRA in 2015
Category DSA Cerebral aneurysm
Ischemic stroke
Vascular malformation
Tumor embolization

Coiling+PAO
Stent or balloon
IIA thrombolysis for cerebral infarction
EC PTA or stent (including CAS)
IC PTA or stent
AVM
Dural AVF or CCF

SKEN HA601-6, HA691-4 SKEN M1662 SKEN M1661 SKEN M6630, M6631, M6633, M6636 + I63 SKEN M6602, M6594 SKEN M6601, M6593 SKEN M1663, M1667, M1668, M1669 SKEN M1664, M1665, M1666 SKEN M1673, M1674, M1675
Seoul 6046 19383 852 1180 421 948 238 445 379 624 61 157 92 171 95 133 108 394
Busan 4462 6629 508 393 387 468 239 228 186 226 51 50 45 21 21 26 51 28
Incheon 1789 2693 254 236 69 66 83 95 42 64 15 18 9 12 6 3 9 7
Daegu 2201 4163 262 304 157 193 106 267 65 132 10 20 9 23 9 11 1 12
Gwangju 643 1915 77 68 54 52 30 123 14 49 2 16 2 7 10 14 3 1
Daejeon 2245 2924 368 295 176 179 114 97 109 120 37 39 12 12 12 7 10 14
Ulsan 767 1545 131 69 51 151 44 58 17 23 13 21 2 3 3 5 2 20
Gyeonggi-do 8447 13818 759 675 679 922 329 471 417 548 158 150 52 59 47 51 124 132
Gangwon-do 963 1709 153 131 65 69 62 52 111 90 43 56 5 6 8 6 3 2
Chungcheongbuk-do 432 1815 72 83 41 73 43 94 44 64 4 26 0 2 1 0 0 5
Chungcheongnam-do 769 1874 107 113 109 155 32 44 68 129 22 25 6 12 8 5 10 13
Jeollabuk-do 1151 2067 146 151 72 39 49 175 97 137 37 46 5 6 16 11 9 9
Jeollanam-do 0 543 0 11 0 12 0 23 0 21 0 8 0 0 0 0 0 1
Gyeongsangbuk-do 2222 3798 250 128 66 164 144 140 99 91 29 35 3 4 2 1 3 3
Gyeongsangnam-do 926 2004 118 152 106 180 162 171 62 88 42 16 1 10 3 9 5 13
Jeju-do 474 771 72 61 28 20 63 37 15 25 16 17 3 0 2 2 11 7
Total 33537 (49.6%) 67651 4129 (102.0%) 4050 2481 (67.2%) 3691 1738 (69.0%) 2520 1725 (71.0%) 2431 540 (77.1%) 700 246 (70.7%) 348 243 (85.6%) 284 349 (52.8%) 661

SKEN : The Society of Korean Endovascular Neurosurgeons, HIRA : the Health Insurance Review & Assessment Service, DSA : digital subtraction angiography, PAO : parent artery occlusion, IA : intra-arterial, EC : extracranial, PTA : percutaneous transluminal angioplasty, CAS : carotid artery stenting, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous fistula

Table 7.
Comparison between data collected from SKEN members and nationwide data from the Healthcare Bigdata Hub of the HIRA in 2016
Category DSA Cerebral aneurysm
Ischemic stroke
Vascular malformation
Tumor embolization

Coiling+PAO
Stent or balloon
IIA thrombolysis for cerebral infarction
EC PTA or stent (including CAS)
IC PTA or stent
AVM
Dural AVF or CCF

SKEN HA601-6, HA691-4 SKEN M1662 SKEN M1661 SKEN M6630, M6631, M6633, M6636 + I63 SKEN M6602, M6594 SKEN M6601, M6593 SKEN M1663, M1667, M1668, M1669 SKEN M1664, M1665, M1666 SKEN M1673, M1674, M1675
Seoul 8380 21915 1055 1266 570 1273 327 502 397 609 85 150 92 167 139 157 168 439
Busan 4602 7074 548 464 485 529 243 231 211 226 35 36 38 26 27 24 47 49
Incheon 2015 2998 249 261 81 71 136 144 67 95 11 13 6 5 5 6 7 10
Daegu 3894 4983 370 330 245 228 260 285 79 137 18 12 12 20 13 13 4 14
Gwangju 488 2120 63 63 55 57 51 142 26 88 2 25 5 8 8 12 2 1
Daejeon 2061 3305 309 221 166 274 124 115 96 157 35 42 19 22 9 5 10 10
Ulsan 283 1936 101 91 66 198 35 52 17 41 12 11 7 10 3 7 5 12
Gyeonggi-do 8579 15140 938 726 834 1076 375 559 455 534 152 183 43 48 61 54 154 139
Gangwon-do 1514 2042 162 144 89 79 93 80 110 85 51 60 7 11 14 8 9 2
Chungcheongbuk-do 615 2165 85 106 45 114 30 86 48 87 13 27 0 3 1 3 1 2
Chungcheongnam-do 1005 2495 123 134 158 228 58 79 65 174 32 41 9 4 10 9 7 6
Jeollabuk-do 1317 2548 179 209 119 55 68 151 96 150 22 46 7 2 10 4 3 8
Jeollanam-do 0 784 0 10 0 18 0 71 0 44 0 10 0 0 0 0 0 0
Gyeongsangbuk-do 2669 4068 292 159 83 186 152 137 83 83 29 31 3 4 2 2 4 3
Gyeongsangnam-do 827 2717 79 123 87 273 182 236 58 131 33 22 0 6 3 16 1 19
Jeju-do 611 734 72 62 21 25 53 42 30 31 2 11 1 1 0 0 5 8
Total 38860 (50.5%) 77024 4625 (105.9%) 4369 3104 (66.3%) 4684 2187 (75.1%) 2912 1838 (68.8%) 2672 532 (73.9%) 720 249 (73.9%) 337 305 (95.3%) 320 427 (59.1%) 722

SKEN : The Society of Korean Endovascular Neurosurgeons, HIRA : the Health Insurance Review & Assessment Service, DSA : digital subtraction angiography, PAO : parent artery occlusion, IA : intra-arterial, EC : extracranial, PTA : percutaneous transluminal angioplasty, CAS : carotid artery stenting, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous fistula

Table 8.
Comparison between data collected from SKEN members and nationwide data from the Healthcare Bigdata Hub of the HIRA in 2017
Category DSA Cerebral aneurysm
Ischemic stroke
Vascular malformation
Tumor embolization

Coiling+PAO
Stent or balloon
IIA thrombolysis for cerebral infarction
EC PTA or stent (including CAS)
IC PTA or stent
AVM
Dural AVF or CCF

SKEN HA601-6, HA691-4 SKEN M1662 SKEN M1661 SKEN M6630, M6631, M6633, M6636 + I63 SKEN M6602, M6594 SKEN M6601, M6593 SKEN M1663, M1667, M1668, M1669 SKEN M1664, M1665, M1666 SKEN M1673, M1674, M1675
Seoul 8964 24477 1162 1392 537 1468 434 642 427 667 103 195 50 142 91 165 147 531
Busan 5310 7326 482 478 418 566 250 282 214 250 43 48 21 24 32 30 38 49
Incheon 2470 3525 314 272 107 114 161 158 102 125 28 30 5 6 10 7 2 8
Daegu 4012 4565 501 391 279 300 250 263 82 147 16 28 13 24 20 13 4 2
Gwangju 412 2358 56 55 53 48 82 196 41 114 40 22 10 9 1 9 0 0
Daejeon 2632 3345 340 204 243 296 147 130 102 141 37 32 25 20 17 11 8 8
Ulsan 839 2258 129 82 142 227 67 75 32 41 19 15 10 13 6 3 9 15
Gyeonggi-do 10667 17000 958 741 857 1162 507 658 485 607 195 180 45 45 70 62 161 213
Gangwon-do 1869 2286 192 171 108 97 127 114 101 91 39 38 10 12 7 4 6 1
Chungcheongbuk-do 501 2145 79 121 111 142 37 116 73 114 28 42 2 4 0 6 1 3
Chungcheongnam-do 1602 2576 166 152 175 213 73 74 123 147 41 48 8 10 7 4 12 12
Jeollabuk-do 1088 2508 196 201 109 74 42 165 53 179 50 37 7 6 6 7 2 5
Jeollanam-do 0 700 0 19 0 26 0 70 0 37 0 8 0 0 0 2 0 0
Gyeongsangbuk-do 2957 4347 311 158 116 213 238 192 140 126 44 47 9 7 2 1 7 5
Gyeongsangnam-do 726 3193 94 148 65 282 197 262 48 118 24 38 2 9 7 15 0 14
Jeju-do 547 659 73 70 28 30 54 45 23 25 12 17 4 3 0 4 4 12
Total 44596 (53.6%) 83268 5053 (108.5%) 4655 3348 (63.7%) 5258 2666 (77.5%) 3442 2046 (69.9%) 2929 719 (87.2%) 825 221 (66.2%) 334 276 (80.5%) 343 401 (45.7%) 878

SKEN : The Society of Korean Endovascular Neurosurgeons, HIRA : the Health Insurance Review & Assessment Service, DSA : digital subtraction angiography, PAO : parent artery occlusion, IA : intra-arterial, EC : extracranial, PTA : percutaneous transluminal angioplasty, CAS : carotid artery stenting, AVM : arteriovenous malformation, AVF : arteriovenous fistula, CCF : carotid-cavernous fistula

Table 9.
The list of the hospitals participated in the 2018 survey
Hospital Regions
Gachon University Gill Medical Center Incheon
Catholic Kwandong University International 乳 Mary's Hospital Incheon
The Catholic University of Korea Daejeon St. Mary's Hospital Daejeon
The Catholic University of Korea Bucheon St. Mary's Hospital Gyeonggi-do
The Catholic University of Korea Seoul St. Mary's Hospital Seoul
The Catholic University of Korea St. Vincent's Hospital Gyeonggi-do
The Catholic University of Korea Uijeongbu St. Mary's Hospital Gyeonggi-do
The Catholic University of Korea Incheon St. Mary's Hospital Incheon
Kyung Hee University Hospital at Gangdong Seoul
Ulsan University Gangneung Asan Hospital Gangwon-do
Kangwon National University Hospital Gangwon-do
Konkuk University Hospital Chungcheongbuk-do
Konyang University Hospital Daejeon
Gumdan Top General Hospital Incheon
Kyungpook National University Hospital Daegu
Gyeongsang National University Hospital Gyeongsangnam-do
Kyunghee National University Hospital Seoul
Kyunghee University Medical Center E&C Jungang General Hospital Gyeongsangnam-do
Keimyung University Dongsan Medical Center Daegu
Korea University Ansan Hospital Gyeonggi-do
Kosin University Gospel Hospital Busan
National Medical Center Seoul
Bongseng Memorial Hospital Busan
Namyangju Hanyang General Hospital Gyeonggi-do
New Korea Hospital Gyeonggi-do
Dankook University Hospital Chungcheongnam-do
Daegu Catholic University Medical Center Daegu
Daegu Fatima Hospital Daegu
Sun Medical Center Daejeon
Daejeon Hankook Hospital Daejeon
Dongkang Medical Center Ulsan
Dongguk University Gyeongju Hospital Gyeongsangbuk-do
Dongguk University Ilsan Hospital Gyeonggi
Donggunsan General Hospital Jeollabuk-do
Dongrae-Bongseng Hospital Busan
Dong-A University Hospital Busan
Dong-Eui Medical Center Busan
Mediplex Sejong Hospital Gyeonggi-do
Myongji Hospital Gyeonggi-do
Myongji St. Mary's Hospital Seoul
Pusan National University Hospital Busan
Seoul National University Bundang Hospital Gyeonggi-do
Bundang Jesaeng Hospital Gyeonggi-do
Seodaegu Hospital Daegu
Ulsan University Asan Medical Center Seoul
Seoul Medical Center Seoul
SMG-SNU Boramae Medical Center Seoul
Kangbuk Samsung Hospital Seoul
Sungkyunkwan University Samsung Changwon Hospital Gyeongsangnam-do
Pohang Semyoung Christian Hospital Gyeongsangbuk-do
Soon Chun Hyang University Hospital Gumi Gyeongsangbuk-do
Soon Chun Hyang University Hospital Bucheon Gyeonggi-do
Soon Chun Hyang University Hospital Seoul Seoul
Soon Chun Hyang University Hospital Cheonan Chungcheongnam-do
Asan Chungmu Hospital Chungcheongnam-do
Ajou University Hospital Gyeonggi-do
Andong Medical Group Hospital Gyeongsangbuk-do
Andong Sungso Hospital Gyeongsangbuk-do
Pohang Stroke and Spine Hospital Gyeongsangbuk-do
Yonsei University Gangnam Severance Hospital Seoul
Yonsei University Severance Hospital Seoul
Wonju Severance Christian Hospital Gangwon-do
Yeungnam University Medical Center Daegu
Presbyterian Medical Center Jeollabuk-do
On Hospital Busan
Ulsan University Ulsan Hospital Ulsan
Wonkwang University Hospital Jeollabuk-do
Sun Medical Center Daejeon
Eulji University Nowon Eulji Medical Center Seoul
Eulji University Daejeon Eulji Medical Center Daejeon
Ewha Womans University Mokdong Hospital Seoul
Hallym Hospital Incheon
Inje University Seoul Paik Hospital Seoul
Inje University Haeundae Paik Hospital Busan
Inha University Hospital Incheon
Chonnam National University Hospital Gwangju
Chonbuk National University Hospital Jeollabuk-do
Jeju National University Hospital Jeju
Cheju Halla General Hospital Jeju
Chosun University Hospital Gwangju
Chung-Ang University Hospital Seoul
VHS Medical Center Seoul
CHA University Kumi Medical Center Gyeongsangbuk-do
CHA University Bundang Medical Center Gyeonggi-do
Chamjoeun Hospital Gyeonggi-do
Cheonan Chungmu Hospital Chungcheongnam-do
Cheongju St. Mary's Hospital Chungcheongbuk-do
Hankook General Hospital Chungcheongbuk-do
Chungnam National University Hospital Daejeon
Pohang St. Mary's Hospital Gyeongsangbuk-do
Hallym University Kangnam Sacred Heart Hospital Seoul
Hallym University Kangdong Sacred Heart Hospital Seoul
Hallym University Dongtan Sacred Heart Hospital Gyeonggi-do
Hallym University Chuncheon Sacred Heart Hospital Gangwon-do
Hallym University Medical Center Gyeonggi-di
Hallym University Hangang Sacred Heart Hospital Seoul
Hanyang University Guri Hospital Gyeonggi-do
Hanyang University Seoul Hospital Seoul
Hongik Hospital Seoul
Hyosung Hospital Chungcheongbuk-do

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