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Historical perspective of carotid artery stenting in Japan: Analysis of 8,092 cases in The Japanese CAS survey

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Abstract

Background and purpose

We conducted a large retrospective survey of the clinical results of carotid artery stenting (CAS) for about 10 years performed by neurointerventionists at 43 Japanese institutions. Hence, the historical perspective of CAS in Japan was demonstrated.

Methods

Cases were stratified into three separate periods based on the approval status of devices: the first period, in which off-label CAS was performed using balloon protection; the second period, using a limited number of approved devices under filter protection; the third period, using appropriate protection selected from several different options based on the preoperative evaluation (tailored CAS). Clinical results were retrospectively evaluated. Then 30-day results of each period were examined. The major adverse event (MAE) was defined as stroke, myocardial infarction or death.

Results

Between January 2001 and December 2010, a total of 8,092 cases were registered, including 4,072, 1,526 and 2,494 in the first, second and third period, respectively. In the first period, 92 % of CAS was performed under balloon protection. In contrast, 91 % was done under filter protection in the second period. In the third period, various protection methods were used, including balloon (31 %), filter (50 %) and proximal protection (18 %). The rate of MAE at 30 days was 6.1 %, 10.2 % and 3.5 % in the first, second and third periods, respectively, and 6.3 % in all periods combined. The rate of MAE in the third period was significantly lower than that in the first and second periods.

Conclusions

The historical paradigm of CAS in Japan was demonstrated. Due to the improvement of devices, increasing experience and appropriate selection of protection, CAS is continuing to evolve into a safer and more efficacious method of stroke prevention.

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Abbreviations

CAS:

Carotid artery stenting

CEA:

Carotid endarterectomy

MAE:

Major adverse event

RCT:

Randomized controlled trial

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Acknowledgments

This study was supported by The Japanese Society for Neuroendovascular Therapy (non-financial support). The authors are very grateful to all the study participants and collaborators. Also, we thank Dr. Nobuyuki Hamajima, Department of Preventive Medicine, Nagoya University Graduate School of Medicine, for statistical analysis and Drs. Takashi Izumi and Noriaki Matsubara, The Neuroendovascular Team, Department of Neurosurgery, Nagoya University Graduate School of Medicine, for their generous assistance with data analysis and preparing this manuscript.

Conflicts of interest

None.

Source of funding

This study was financially supported by the research grant program of Nagoya University.

Disclosure

S. Miyachi has received funding from the Foundation for Biomedical Research and Innovation.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Shigeru Miyachi

  2. Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan

    Waro Taki

  3. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan

    Nobuyuki Sakai

  4. Department of Neurosurgery, Kokura Memorial Hospital, Kokura, Fukuoka, Japan

    Ichiro Nakahara

Authors
  1. Shigeru Miyachi
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  2. Waro Taki
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  3. Nobuyuki Sakai
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  4. Ichiro Nakahara
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Consortia

The Japanese CAS Survey Investigators

Corresponding author

Correspondence to Shigeru Miyachi.

Additional information

Japanese investigators and sites particiapting in the CAS survey

Eiichi Kobayashi, M.D. (Department of Neurosurgery, Chiba University, Chiba), Shinichi Tamatani, M.D. (Department of Neurosurgery, Dokkyo Medical University, Tochigi), Akio Hyodo, M.D., Kensuke Suzuki, M.D. (Department of Neurosurgery, Dokkyo Medical University, Koshigaya Hospital, Saitama), Shinichi Yoshimura, M.D., Yusuke Egashira, M.D. (Department of Neurosurgery, Gifu University, Gifu), Mitsugu Nakamura, M.D. (Department of Neurosurgery, Himeji Stroke Center, Hyogo), Yoshihiro Kiura, M.D., Shigeyuki Sakamoto, M.D. (Department of Neurosurgery, Hiroshima University, Hiroshima), Hidenori Oishi, M.D. (Department of Neurosurgery, Juntendo University, Tokyo), Tetsuya Nagayama, M.D. (Department of Neurosurgery, Kagoshima University, Kagoshima), Nobuhiro Nakagawa, M.D. (Department of Neurosurgery, Kinki University, Osaka), Nobuyuki Sakai, M.D., Toshihiro Imamura, M.D. (Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe), Ichiro Nakahara, M.D., Hiroshi Fukushima, M.D. (Department of Neurosurgery, Kokura Memorial Hospital, Kitakyusyu), Yasushi Matsumoto, M.D., Ryuji Kondo, M.D. (Department of Endovascular Neurosurgery, Konan Hospital, Sendai), Masaru Hiroharta, M.D., (Department of Neurosurgery, Kurume University, Fukuoka), Mamoru Murakami, M.D. (Department of Neurosurgery, Kyoto Medical Center, Kyoto), Akira Ishii, M.D. (Department of Neurosurgery, Kyoto University, Kyoto), Waro Taki, M.D., Naoki Toma, M.D. (Department of Neurosurgery, Mie University, Mie), Kazunori Akaji, M.D. (Department of Neurosurgery, Mihara Memorial Hospital, Gunma), Yoshihiro Ito, M.D. (Department of Neurosurgery, Mito Medical Center, Mito), Gohei So, M.D. (Department of Neurosurgery, Nagasaki University, Nagasaki), Shigeru Miyachi, M.D., Takashi Izumi, M.D., Noriaki Matsubara, M.D., Takehiro Naito, M.D., Kenichi Haraguchi, M.D., Takumi Asai M.D., Takashi Yamanouchi, M.D. (Department of Neurosurgery, Nagoya University, Nagoya), Toshio Hyogo, M.D., (Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo), Yasushi Ito, M.D., (Department of Neurosurgery, Niigata University, Niigata), Hiro Kiyosue, M.D. (Department of Radiology, Oita University, Oita), Kenji Sugiu, M.D., Koji Tokunaga, M.D. (Department of Neurosurgery, Okayama University, Okayama), Shuta Aketa, M.D. (Department of Neurosurgery, Osaka Police Hospital, Osaka), Toshiyuki Fujinaka, M.D. (Department of Neurosurgery, Osaka University, Osaka), Hajime Shibuya, M.D. (Department of Neuroendovascular Therapy, Sagamihara Kyodo Hospital, Kanagawa), Toshihiro Ueda, M.D. (Stroke center, St. Marianna Medical University, Toyoko Hospital, Kanagawa), Satoshi Iihoshi, M.D. (Department of Neurosurgery, Sapporo Medical University, Sapporo), Masayuki Ezura, M.D. (Department of Neurosurgery, Sendai Medical Center, Sendai), Hisashi Nagashima, M.D. (Department of Neurosurgery, Shinshu University, Matsumoto), Kenichi Murao, M.D., Kazutomo Nakazawa, M.D., Kosuke Miyake, M.D. (Department of Neuroendovascular Therapy, Shiroyama Hospital, Osaka), Hiroshi Abe, M.D. (Department of Neurosurgery, Tachikawa General Hospital, Niigata), Satoshi Iwabuchi, M.D. (Department of Neurosurgery, Toho Univeristy, Ohashi Hospital, Tokyo), Masataka Takeuchi, M.D. (Department of Neurosurgery, Tokai University, Kanagawa), Koichi Sato, M.D. (Department of Neuro-Endovascular Surgery, Tokushima Red Cross Hospital, Tokushima), Junichiro Satomi, M.D. (Department of Neurosurgery, Tokushima University, Tokushima), Masaki Katayama, M.D. (Department of Neurosurgery, Tokyo Dental College, Ichikawa Hospital, Tokyo), Yuichi Murayama, M.D., Toshihiro Ishibashi, M.D. (Department of Neurosurgery, Tokyo Jikei University, Tokyo), Hiroaki Sato, M.D. (Department of Neurosurgery, Tokyo Police Hospital, Tokyo), Yuji Matsumaru, M.D. (Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo), Makoto Sakamoto, M.D. (Department of Neurosurgery, Tottori University, Tottori), Naoya Kuwayama, M.D., Naoki Akiyama, M.D. (Department of Neurosurgery, Toyama University, Toyama), Michiya Kubo, M.D. (Department of Neurosurgery, Toyama Saiseikai Hospital, Toyama), Hideki Sakai, M.D. (Department of Neurosurgery, Toyohashi Medical Center, Aichi), Susumu Masuo, M.D. (Department of Neurosurgery, Wakayama Medical University, Wakayama), Tomoaki Terada, M.D. (Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama), Masafumi Morimoto, M.D. (Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama).

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Miyachi, S., Taki, W., Sakai, N. et al. Historical perspective of carotid artery stenting in Japan: Analysis of 8,092 cases in The Japanese CAS survey. Acta Neurochir 154, 2127–2137 (2012). https://doi.org/10.1007/s00701-012-1508-9

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