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Initial results of carotid artery stenting in Japan

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Abstract

Carotid artery stenting (CAS) was approved by the government and reimbursement was started in 2008 in Japan, probably the last country in the world. CASCARD is a retrospective registry study performed by cardiologists to assess initial results of CAS in Japan. CAS was indicated for patients with at least one high risk factor for carotid endarterectomy and with >50 % stenosis in symptomatic or >80 % stenosis in asymptomatic patients. Primary endpoint was major adverse events (MAE) including death, myocardial infarction and any stroke at 30 days. Between April 2008 and March 2010, a total of 704 cases were enrolled from 55 centers. The study population with an average age of 74 ± 8 years included 62 % asymptomatic patients, with 23 % of cases with contralateral carotid artery occlusion or significant stenoses. Angioguard filter wire was exclusively used as a primary protection device and successfully passed the lesion in 701 cases (99.6 %). Precise stent was implanted successfully in all cases. MAE at 30 days was 3.7:0.3 % death, 0 % myocardial infarction, and 3.4 % stroke (0.4 % major ipsilateral stroke). Death or any stroke rate at 30 days was 2.7 % in asymptomatic and 5.5 % in symptomatic patients. The CASCARD study showed that the initial results of CAS in Japan are acceptable for both symptomatic and asymptomatic cases.

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References

  1. Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke. 1999;30:2513–6.

    Article  PubMed  CAS  Google Scholar 

  2. Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37:1583–633.

    PubMed  Google Scholar 

  3. Adams RJ, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2008;39:1647–52.

    Article  PubMed  Google Scholar 

  4. Ederle J, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev. 2007;4:CD000515.

    Google Scholar 

  5. Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clement D, Collet JP, et al. ESC guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2851–906.

    Article  PubMed  Google Scholar 

  6. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–501.

    Article  PubMed  CAS  Google Scholar 

  7. Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368:1239–47.

    Article  PubMed  CAS  Google Scholar 

  8. Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–71.

    Article  PubMed  CAS  Google Scholar 

  9. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.

    Article  PubMed  CAS  Google Scholar 

  10. Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation. 2011;124:489–532.

    Article  PubMed  Google Scholar 

  11. Theiss W, Hermanek P, Mathias K, Bruckmann H, Dembski J, Hoffmann FJ, et al. Predictors of death and stroke after carotid angioplasty and stenting: a subgroup analysis of the Pro-CAS data. Stroke. 2008;39:2325–30.

    Article  PubMed  Google Scholar 

  12. Iyer SS, White CJ, Hopkins LN, Katzen BT, Safian R, Wholey MH, et al. Carotid artery revascularization in high-surgical-risk patients using the Carotid WALLSTENT and FilterWire EX/EZ: 1-year outcomes in the BEACH Pivotal Group. J Am Coll Cardiol. 2008;51:427–34.

    Article  PubMed  Google Scholar 

  13. Katzen BT, Criado FJ, Ramee SR, Massop DW, Hopkins LN, Donohoe D, et al. Carotid artery stenting with emboli protection surveillance study: thirty-day results of the CASES-PMS study. Catheter Cardiovasc Interv. 2007;70:316–23.

    Article  PubMed  Google Scholar 

  14. Gray WA, Hopkins LN, Yadav S, Davis T, Wholey M, Atkinson R, et al. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg. 2006;44:258–68.

    Article  PubMed  Google Scholar 

  15. Gray WA, Yadav JS, Verta P, Scicli A, Fairman R, Wholey M, et al. The CAPTURE registry: results of carotid stenting with embolic protection in the post approval setting. Catheter Cardiovasc Interv. 2007;69:341–8.

    Article  PubMed  Google Scholar 

  16. Chikkaswamy SB, Rai MK, Nagesh CM, Reddy B, Dinesha B, Manjunath CN. Preventing a central nervous system catastrophe in a case of Takayasu’s arteritis presenting with critical stenosis of all three arch vessels. Cardiovasc Interv Ther. 2012;27:118–20.

    Article  PubMed  Google Scholar 

  17. Nakao T, Kimura T, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, et al. The long-term efficacy of cilostazol in addition to dual antiplatelet therapy after sirolimus-eluting stent implantation for Japanese patients: an analysis of the 3-year follow-up outcomes from the j-Cypher registry. Cardiovasc Interv Ther. 2012;27:161–167

    Google Scholar 

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Acknowledgments

We thank Ms Sachiko Yajima for data management.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Tokai University Hospital, 143 Shimokasuya Isehara, 259-1193, Kanagawa, Japan

    Yuji Ikari & Nobuhiko Ogata

  2. Chiba-Nishi General Hospital, Chiba, Japan

    Kazuo Misumi

  3. Kokura Memorial Hospital, Kokura, Japan

    Hiroyoshi Yokoi

  4. Kasai Cardiology and Neurosurgery Hospital, Tokyo, Japan

    Tomoyuki Umemoto

  5. Ogaki Municipal Hospital, Gifu, Japan

    Michitaka Uesugi

  6. Toyohashi Heart Center, Aichi, Japan

    Yoshihisa Kinoshita

  7. Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan

    Masatsugu Nakano

  8. Tokyo Women’s Medical University Hospital, Tokyo, Japan

    Michiaki Higashitani

  9. Sanyudo Hospital, Yamagata, Japan

    Hideki Abe

  10. Kasukabe Chuo General Hospital, Saitama, Japan

    Hiroshi Ando

  11. The Sakakibara Heart Institute of Okayama, Okayama, Japan

    Keizou Yamamoto

  12. Mitsui Memorial Hospital, Tokyo, Japan

    Shuzou Tanimoto

Authors
  1. Yuji Ikari
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  2. Kazuo Misumi
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  3. Hiroyoshi Yokoi
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  4. Nobuhiko Ogata
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  5. Tomoyuki Umemoto
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  6. Michitaka Uesugi
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  7. Yoshihisa Kinoshita
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  8. Masatsugu Nakano
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  9. Michiaki Higashitani
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  10. Hideki Abe
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  11. Hiroshi Ando
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  12. Keizou Yamamoto
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  13. Shuzou Tanimoto
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Corresponding author

Correspondence to Yuji Ikari.

Appendix: CASCARD investigators

Appendix: CASCARD investigators

Yuji Ikari was the principal investigator.

Kazuo Misumi (Chiba-Nishi General Hospital, Chiba, Japan), Hiroyoshi Yokoi (Kokura Memorial Hospital, Kokura, Japan), Yuji Ikari, Nobuhiko Ogata, (Tokai University Hospital, Kanagawa, Japan), Tomoyuki Umemoto (Kasai Cardiology & Neurosurgery Hospital, Tokyo, Japan), Michitaka Uesugi (Ogaki Municipal Hospital, Gifu, Japan), Yoshihisa Kinoshita (Toyohashi Heart Center, Aichi, Japan), Masatsugu Nakano (Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan), Michiaki Higashitani (Tokyo Women’s Medical University Hospital, Tokyo, Japan), Hideki Abe (Sanyudo Hospital, Yamagata Japan), Hiroshi Ando (Kasukabe Chuo General Hospital, Saitama, Japan), Keizo Yamamoto (The Sakakibara Heart Institute of Okayama, Okayama, Japan), Syuzo Tanimoto (Mitsui Memorial Hospital, Tokyo, Japan), Hideo Nishikawa (Mie Heart Center, Mie, Japan) Yasukazu Takei (Saitama Red Cross Hospital, Saitama, Japan), Eijiro Hayashi (Fukuroi Municipal Hospital, Shizuoka, Japan), Shinichiro Yokoyama (Tokyo Hokubu Hospital, Tokyo, Japan), Satoshi Takeshita (Shonankamakura General Hospital, Kanagawa Japan), Hisashi Matsumoto (Mimihara General Hospital, Osaka, Japan), Kojiro Awano (Miki City Hospital, Hyogo, Japan), Tomoyuki Kunishima (Teikyo University School of Medicine University Hospital, Mizonokuchi, Japan), Yoshiaki Yokoi (Kishiwada Tokushukai Hospital Osaka, Japan), Nobuo Shiode (Tsuchiya General Hospital, Hiroshima, Japan), Mitsugu Hirokami (Teine Keijinkai Hospital, Hokkaido, Japan), Naofumi Doi (Mimuro Hospital, Nara, Japan), Shigeru Nakamura (Kyoto-Katsura Hospital, Kyoto, Japan), Kan Zen (Omihachiman Community Medical Center, Shiga, Japan), Norihiko Shinozaki (Shinonoi General Hospital, Nagano, Japan), Kinzo Ueda (Rakuwakai Marutamachi Hospital, Kyoto, Japan), Mikio Ishizuka (Totsuka Kyouritsu Daini Hospital, kanagawa, Japan), Toru Higa (Fukuoka Wajiro Hospital, Fukuoka, Japan), Toshiyuki Matsumura, Hideki Doi (Kumamoto Rosai Hospital, Kumamoto, Japan), Juji Sugioka (Funabashi Municipal Medical Center, Chiba, Japan), Joji Hosokawa, (Tokyo Heart Center, Tokyo, Japan), Sumio Mizuno (Fukui CardioVascular Center, Fukui, Japan), Minoru Yamada (Shizuoka Saiseikai General Hospital, Shizuoka, Japan), Yuichi Ujiie, (Hoshi General Hospital, Fukushima, Japan), Yutaka Koyama (Synthesis Shinkawabashi Hospital, Kanagawa, Japan), Mitsutaka Yamamoto (Fukuoka Seisyukai Hospital, Fukuoka, Japan), Masahito Kawata, (Akashi Medical Center, Hyogo, Japan), Mitsuru Munemasa, (Okayama Medical Center, Okayama, Japan), Takeshi Tokunaga, (JA Toride Medical Center, Ibaraki, Japan), Ryu Shutta, (Osaka Rosai Hospital, Osaka, Japan), Norikazu Takechi (Tanabe Central Hospital, Kyoto, Japan), Ryo Goto (Shuwa General Hospital, Saitama, Japan), Hiroshi Araki (Showa University Northern Yokohama Hospital, Kanagawa, Japan), Makoto Sato (Nakadori General Hospital, Akita, Japan), Hideyuki Koga (Fukuoka Higashi Medical Center, Fukuoka Japan), Yasunori Nishida (Kouseikai Takai Hospital, Nara, Japan),

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Ikari, Y., Misumi, K., Yokoi, H. et al. Initial results of carotid artery stenting in Japan. Cardiovasc Interv and Ther 28, 37–44 (2013). https://doi.org/10.1007/s12928-012-0134-z

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  • DOI: https://doi.org/10.1007/s12928-012-0134-z

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