Safety and feasibility of neuroendovascular therapy for elderly patients: Analysis of Japanese registry of neuroendovascular therapy 3

Koichi Arimura, Koji Iihara, Tetsu Satow, ataru nishimura, So Tokunaga, Nobuyuki Sakai

研究成果: ジャーナルへの寄稿記事

抄録

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.

元の言語英語
ページ(範囲)305-312
ページ数8
ジャーナルNeurologia medico-chirurgica
59
発行部数8
DOI
出版物ステータス出版済み - 1 1 2019

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Registries
Safety
Odds Ratio
Confidence Intervals
Therapeutics
Carotid Stenosis
Aneurysm
Cerebrovascular Disorders
Magnetic Resonance Angiography
Intracranial Aneurysm
Patient Selection
Stents
Japan
Multivariate Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

これを引用

Safety and feasibility of neuroendovascular therapy for elderly patients : Analysis of Japanese registry of neuroendovascular therapy 3. / Arimura, Koichi; Iihara, Koji; Satow, Tetsu; nishimura, ataru; Tokunaga, So; Sakai, Nobuyuki.

:: Neurologia medico-chirurgica, 巻 59, 番号 8, 01.01.2019, p. 305-312.

研究成果: ジャーナルへの寄稿記事

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abstract = "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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AU - Arimura, Koichi

AU - Iihara, Koji

AU - Satow, Tetsu

AU - nishimura, ataru

AU - Tokunaga, So

AU - Sakai, Nobuyuki

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