TY - JOUR
T1 - Safety and feasibility of neuroendovascular therapy for elderly patients
T2 - Analysis of Japanese registry of neuroendovascular therapy 3
AU - Arimura, Koichi
AU - Iihara, Koji
AU - Satow, Tetsu
AU - Nishimura, Ataru
AU - Tokunaga, So
AU - Sakai, Nobuyuki
N1 - Funding Information:
N. Sakai received Speakers’ Bureau/Honoraria from Otsuka Pharmaceutical Co., Stryker Co., Medtronic Co., Medico’s Hirata Co., and Biomedical Solutions Co., and research funding from Otsuka Pharmaceutical Co., Terumo Co., and Daiichi Sankyo Co. K. Iihara received Speakers’ Bureau/Honoraria from Otsuka Pharmaceutical Co., and research funding from Otsuka Pharmaceutical Co., Mitsubishi Tanabe Pharma Co., Kaneka Medix Co., Chugai Pharmaceutical Co., and Eizai Co. K. Arimura, T. Sato, A. Nishimura, and S. Tokunaga had no conflicts of interest to declare. All authors who are members of the Japan Neurosurgical Society (JNS) have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.
Funding Information:
This study was supported in part by a Grant-in-Aid (Junkanki-Kaihatsu H24-4-3) from the National Cerebral and Cardiovascular Center, Japan and by Hatazaki Foundation, Kobe, Japan.
Funding Information:
The JR-NET3 Study Group: Co-principal investigator; Nobuyuki Sakai, Kobe City Medical Center General Hospital, Kobe, Japan, Koji Iihara, Kyushu University, Fukuoka, Japan, Tetsu Satow, National Cerebral and Cardiovascular Center, Suita, Japan; investigators; Masayuki Ezura, Sendai Medical Center, Sendai, Japan, Akio Hyodo, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan, Shigeru Miyachi, Aichi Medical University, Aichi, Japan, Susumu Miyamoto, Kyoto University, Kyoto, Japan, Yoji Nagai, Kobe University, Kobe, Japan, Kunihiro Nishimura, National Cerebral and Cardiovascular Center, Suita, Japan, Kazunori Toyoda, National Cerebral and Cardiovascular Center, Suita, Japan; Co-investigators; Toshiyuki Fujinaka, Osaka Medical Center, Osaka, Japan, Toshio Higashi, Fukuoka University, Fukuoka, Japan, Masaru Hirohata, Kurume University, Kurume, Japan, Akira Ishii, Kyoto University, Kyoto, Japan, Hirotoshi Imamura, Kobe City Medical Center General Hospital, Kobe, Japan, Yasushi Ito, Shinrakuen Hospital, Niigata, Japan, Naoya Kuwayama, Toyama University, Toyama, Japan, Hidenori Oishi, Juntendo University, Tokyo, Japan, Yuji Matsumaru, Tsukuba University, Tsukuba, Japan, Yasushi Matsumoto, Konan Hospital, Sendai, Japan, Ichiro Nakahara, Fujita Health University, Aichi, Japan, Chiaki Sakai, Hyogo College of Medicine, Nishinomiya, Japan, Kenji Sugiu, Okayama University, Okayama, Japan, Tomoaki Terada, Showa University Fujigaoka Hospital, Kanagawa, Japan, Shinichi Yoshimura, Hyogo College of Medicine, Nishinomiya, Japan, and Certified Specialist of Japanese Society of Neuroendovascular Therapy.
Publisher Copyright:
© 2019 by The Japan Neurosurgical Society.
PY - 2019
Y1 - 2019
N2 - Japan has a rapidly aging population and the application of neuroendovascular therapy (NET) for cerebrovascular diseases among elderly patients has increased, but feasibility and safety of NET for elderly patients are still debated. Therefore, this study aimed to elucidate feasibility and safety of NET by analyzing the Japanese nationwide database, the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET 3). In total, 35,972 patients in the JR-NET 3 were analyzed retrospectively. “Elderly patients” were defined as those aged ≥75 years. Approximately one-quarter of patients who received NET were elderly patients. The proportion of patients with modified Rankin Scale (mRS) 0–2 before treatment and 30 days after NET was significantly low across all diseases in the elderly patients. Technical success rates were generally high across all procedures, but complication rate was significantly higher among elderly patients; ischemic complications were significantly higher with NET for unruptured aneurysms (UA) and carotid artery stenosis (CAS). Multivariate analysis revealed that mRS 0–2 before treatment [odds ratio (OR): 0.56, 95% confidence interval (CI): 0.34–0.94, P = 0.03], middle cerebral artery aneurysm (OR: 0.33, 95% CI: 0.12–0.92, P = 0.04), and complete obliteration (OR: 0.66, 95% CI: 0.44–0.97, P = 0.03) were associated with ischemic complications with NET for UA. Moreover, mRS 0–2 before treatment (OR: 0.55, 95% CI: 0.36–0.86, P < 0.01), high intensity with time-of-flight magnetic resonance angiography (OR: 1.55, 95% CI: 1.03–2.32, P = 0.04), open-cell stent (OR: 2.20, 95% CI: 1.50–3.22, P <0.01) were associated with ischemic complications with NET for CAS. Taken together, our findings indicate that cautious and precise selection of patients suitable for NET is necessary.
AB - Japan has a rapidly aging population and the application of neuroendovascular therapy (NET) for cerebrovascular diseases among elderly patients has increased, but feasibility and safety of NET for elderly patients are still debated. Therefore, this study aimed to elucidate feasibility and safety of NET by analyzing the Japanese nationwide database, the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET 3). In total, 35,972 patients in the JR-NET 3 were analyzed retrospectively. “Elderly patients” were defined as those aged ≥75 years. Approximately one-quarter of patients who received NET were elderly patients. The proportion of patients with modified Rankin Scale (mRS) 0–2 before treatment and 30 days after NET was significantly low across all diseases in the elderly patients. Technical success rates were generally high across all procedures, but complication rate was significantly higher among elderly patients; ischemic complications were significantly higher with NET for unruptured aneurysms (UA) and carotid artery stenosis (CAS). Multivariate analysis revealed that mRS 0–2 before treatment [odds ratio (OR): 0.56, 95% confidence interval (CI): 0.34–0.94, P = 0.03], middle cerebral artery aneurysm (OR: 0.33, 95% CI: 0.12–0.92, P = 0.04), and complete obliteration (OR: 0.66, 95% CI: 0.44–0.97, P = 0.03) were associated with ischemic complications with NET for UA. Moreover, mRS 0–2 before treatment (OR: 0.55, 95% CI: 0.36–0.86, P < 0.01), high intensity with time-of-flight magnetic resonance angiography (OR: 1.55, 95% CI: 1.03–2.32, P = 0.04), open-cell stent (OR: 2.20, 95% CI: 1.50–3.22, P <0.01) were associated with ischemic complications with NET for CAS. Taken together, our findings indicate that cautious and precise selection of patients suitable for NET is necessary.
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U2 - 10.2176/nmc.oa.2018-0325
DO - 10.2176/nmc.oa.2018-0325
M3 - Article
C2 - 31130572
AN - SCOPUS:85071352444
VL - 59
SP - 305
EP - 312
JO - Neurologia Medico-Chirurgica
JF - Neurologia Medico-Chirurgica
SN - 0470-8105
IS - 8
ER -