Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 54, Issue 1
Displaying 1-11 of 11 articles from this issue
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Special Theme Topic: Japanese Surveillance of Neuroendovascular Therapy in JR-NET/JR-NET2—Part I
  • Recent Trends in Neuroendovascular Therapy in Japan: Analysis of a Nationwide Survey—Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2
    Nobuyuki SAKAI, Shinichi YOSHIMURA, Waro TAKI, Akio HYODO, Shigeru MIY ...
    2014 Volume 54 Issue 1 Pages 1-8
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: December 27, 2013
    DOIhttps://doi.org/10.2176/nmc.oa.2013-0197
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    The present study retrospectively analyzed the database of the Japanese Registry of Neuroendovascular Therapy 1 and 2 (JR-NET1&2) to determine annual trends, including adverse events and clinical outcomes at 30 days after undergoing neuroendovascular therapy. JR-NET1&2 are surveys that targeted all patients in Japan who underwent neuroendovascular therapy delivered by physicians certified by the Japanese Society of Neuroendovascular Therapy (JSNET) between 2005 and 2009. Medical information about the patients was anonymized and retrospectively registered via a website. Data from 32,608 patients were analyzed. The number of treated patients constantly increased from 5,040 in 2005 to 7,406 in 2009 and the rate of octogenarians increased from 7.0% in 2005 to 10.4% in 2009. The proportion of procedures remained relatively constant, but ratios of angioplasty slightly increased from 32.8% in 2005 to 33.7% in 2009. Procedural complications were associated more frequently with acute stroke (9.6%), ruptured aneurysms (7.4%), intracranial artery disease (ICAD) (5.4%), and arteriovenous malformation (AVM, 5.2%). The number of patients requiring neuroendovascular treatment in Japan is increasing and the outcomes of such therapy are clinically acceptable. Details of each type of treatment will be investigated in sub-analyses of the database.
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  • Current Perioperative Management of Anticoagulant and Antiplatelet Use in Neuroendovascular Therapy: Analysis of JR-NET1 and 2
    Yukiko ENOMOTO, Shinichi YOSHIMURA, Nobuyuki SAKAI, Yusuke EGASHIRA, t ...
    2014 Volume 54 Issue 1 Pages 9-16
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0160
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    To evaluate current perioperative antithrombotic management in neuroendovascular therapy in Japan, we analyzed perioperative anticoagulant and antiplatelet use in various procedures and examined their relationships with periprocedural adverse events. Patient’s data from nationwide surveys administered by the Japanese Registry of Neuroendovascular Therapy (JR-NET) between January 2005 and December 2007 (JR-NET1) and January 2008 and December 2009 (JR-NET2) were retrospectively analyzed. Compared to JR-NET1, the frequency of perioperative antiplatelet therapy and dual or triple therapy were increased for either aneurysm coiling and percutaneous transluminal angioplasty or stenting in JR-NET2. Although ischemic complications were significantly decreased (4.2% vs. 2.1%, p < 0.001), hemorrhagic complications (2.1% vs. 5.3%, p < 0.001), severe adverse events (1.5% vs. 2.1%, p < 0.001), and total perioperative complications (8.3% vs. 10.3%, p < 0.001) were significantly increased in JR-NET2. The rate of hemorrhagic complications was significantly higher in patients with triple or more perioperative antiplatelet therapy (preoperative: 5.3% vs. 9.2%, p < 0.0001, postoperative: 5.7% vs. 12.7%, p < 0.0001). Perioperative antithrombotic therapy was performed more frequently and intensively in neuroendovascular therapy in Japan. While ischemic complications were decreased, hemorrhagic complications and severe adverse events were increased. These results suggest that intensive antithrombotic therapy has a potential risk of hemorrhagic complications for Japanese patients.
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  • Detailed Analysis of Puncture Site Vascular Complications in Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET2
    Masayuki SATO, Yuji MATSUMARU, Nobuyuki SAKAI, Shinichi YOSHIMURA
    2014 Volume 54 Issue 1 Pages 17-22
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: November 20, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0196
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    A subgroup analysis of access site complications in the Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET2, which were retrospective registry studies, was performed. Puncture site vascular complications occurred in 195 (0.63%, mean age: 69.2) of all 31,836 patients. Most of these complications resulted from surgery in main hospitals (186 patients, 0.67%, P < 0.001) and scheduled surgery (167 patients, 0.73%, P < 0.001). Carotid artery stenting (81 patients, 1.04%, p < 0.001), extracranial percutaneous transluminal angioplasty (PTA) (15 patients, 1.02%, p < 0.001), and intracranial PTA (10 patients, 0.81%, p < 0.05) were associated with significantly higher incidence of complications. The incidence of puncture site vascular complications was correlated with the number of antiplatelet drugs (p < 0.001) and intraoperative heparinization (p < 0.05).
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  • Endovascular Treatment of Acute Stroke with Major Vessel Occlusion before Approval of Mechanical Thrombectomy Devices in Japan: Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET 2
    Mikito HAYAKAWA, Hiroshi YAMAGAMI, Nobuyuki SAKAI, Yuji MATSUMARU, Shi ...
    2014 Volume 54 Issue 1 Pages 23-31
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: November 29, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0155
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    The aim of this study was to clarify the general status and historical transition of endovascular therapy (EVT) of acute stroke with major vessel occlusion before approval of mechanical thrombectomy devices in Japan from January 2005 to December 2009. We extracted 1,409 acute ischemic stroke patients receiving EVT (513 women, 69.8 ± 11.8 years) from two nationwide registry studies, the Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET 2. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 18, and 81.3% of the patients received EVT within 6 hours after symptom onset. The culprit occluded arteries were the internal carotid artery (ICA) in 21.2%, middle cerebral artery (MCA) in 53.0%, and basilar artery (BA) in 20.6%. Intravenous thrombolysis was administered to 6.7% of the patients, and EVT mainly consisted of intra-arterial thrombolysis and percutaneous balloon angioplasty/balloon clot disruption. The final recanalization rate was 82.5%, and the clinical outcome was favorable in 35.8% and fatal in 11.6% at 30 days after onset or at discharge. There was no significant change in neurological severity at baseline throughout the study period, but the onset-to-treatment time became longer and the proportion of ICA or BA occlusion increased annually. Although the final recanalization rate was similar throughout the study period, the incidence of a favorable outcome tended to decreased annually from 41.0% to 29.0%. These results could be considered as baseline data that can be used to validate the beneficial effects of novel EVT devices in Japan.
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  • Real-world Experience of Carotid Artery Stenting in Japan: Analysis of 7,134 Cases from JR-NET1 and 2 Nationwide Retrospective Multi-center Registries
    Yusuke EGASHIRA, Shinichi YOSHIMURA, Nobuyuki SAKAI, Yukiko ENOMOTO, t ...
    2014 Volume 54 Issue 1 Pages 32-39
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0187
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    The present study aimed to demonstrate the “real-world” experiences of carotid artery stenting (CAS) in Japan using Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2, retrospective nationwide multi-center surveillances. JR-NET1 and 2 registries are retrospective surveillances conducted between January 2005 and December 2007 and January 2008 and December 2009, respectively, in Japan regarding neuroendovascular therapy. A total of 7,134 procedures (1,943 for JR-NET1 and 5,191 for JR-NET2) were included in this study and retrieved data were analyzed retrospectively. Treatment results of two surveillance periods were similar. In JR-NET2 registry, total of 5,191 lesions were treated by CAS and 5,008 of 5,191 procedures (96.5%) were performed by the board-certified surgeons of Japanese Society of Neuroendovascular Therapy. The rate of technical success was extremely high (99.99%), and the rate of clinically significant complication was low (3.2%). These results were comparable to a previous large study in Japan. Multivariate logistic analysis revealed that age [odds ratio (OR), 1.04 per year; 95% confidence interval (CI), 1.02–1.07; p = 0.0004), symptomatic lesion (OR, 1.87; 95% CI; p = 0.0004), and the use of closed-cell type stent (OR, 0.58; 95% CT, 0.32–1.00; p = 0.05) were independently associated with clinically significant complications. It was revealed that good clinical results were achieved in patients who underwent CAS in Japan. It is expected that the evolution of devices and increasing experiences of surgeons would lead to further improvement of the clinical results, and further investigation would be required to clarify the optimal treatment strategy and therapeutic efficacy of CAS, especially in symptomatic lesions.
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  • Japanese Registry of Neuroendovascular Therapy: Extracranial Steno-occlusive Diseases except for Internal Carotid Artery Stenosis
    Takayuki KIKUCHI, Akira ISHII, Ichiro NAKAHARA, Susumu MIYAMOTO, Nobuy ...
    2014 Volume 54 Issue 1 Pages 40-45
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: November 21, 2013
    DOIhttps://doi.org/10.2176/nmc.st2013-0194
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    Although utilization of endovascular treatment of extracranial steno-occlusive lesions except for internal carotid artery stenosis continues to increase, there is no consensus regarding the natural course and standard treatment of these lesions. The aim of this study was to characterize the utility of endovascular treatment for extracranial steno-occlusive lesions except for internal carotid artery stenosis. A total of 1249 procedures for extracranial steno-occlusive lesions were identified from the Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET2. Excluding the cases of carotid lesions (290 cases), endovascular procedures were performed for 471 (37.7%) subclavian artery stenoses, 404 (32.3%) extracranial vertebral artery stenoses, and 38 (3.0%) innominate artery stenoses with a technical success rate of 97.2%. A stent was placed for 783 lesions and percutaneous transluminal angioplasty was performed for 183 lesions. Forty complications were reported in this cohort. Among these, ischemic complications were the most frequent (12 cases). Comparison between JR-NET1 and JR-NET2 demonstrated a marked increase in the number of procedures, a change in the utilization of antiplatelet therapy, and an increased rate of favorable outcome. We conclude that the endovascular treatment for extracranial steno-occlusive lesions is relatively safe. Continuous efforts should be made to reduce the complication rate, and further trials are needed to validate the beneficial effect of this procedure.
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  • Angioplasty and Stenting for Intracranial Stenosis
    Takashi IZUMI, Hirotoshi IMAMURA, Nobuyuki SAKAI, Shigeru MIYACHI
    2014 Volume 54 Issue 1 Pages 46-53
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: December 27, 2013
    DOIhttps://doi.org/10.2176/nmc.oa.2013-0319
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    Of the patients enrolled in the Japanese Registry of Neuroendovascular Therapy (JR-NET), a surveillance study in Japanese, 1133 patients who underwent intracranial percutaneous transluminal angioplasty (PTA)/stenting for intracranial stenosis during the period from 2005 to 2009 were investigated. A technical success was achieved in 98.3% of the patients, and 70.5% and 7.5% had a residual stenosis of < 30% and ≥ 50%, respectively. The incidence of ischemic complications and hemorrhagic complications was as low as 7.7% and 2.5%, respectively, but tended to increase in patients who underwent stenting. While a significant correlation with ischemic complications was observed in previously untreated patients and patients who underwent stenting followed by post-dilatation, a significant correlation with hemorrhagic complications was observed in patients who received emergency treatment and those treated between 24 hours and 14 days of the onset. Flexible intracranial stents are expected to contribute to improvement in the treatment outcome.
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  • Endovascular Embolization of Cerebral Arteriovenous Malformations: Results of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2
    Ryushi KONDO, Yasushi MATSUMOTO, Hidenori ENDO, Shigeru MIYACHI, Masay ...
    2014 Volume 54 Issue 1 Pages 54-62
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: November 29, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0183
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    This retrospective study constitutes a part of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2. Its purpose is to evaluate the feasibility, safety, and outcome of endovascular embolization for cerebral arteriovenous malformations (AVMs) in Japan. Nine hundred and eighty-seven embolization procedures were registered with JR-NET 1 and 2 (424 procedures in 122 institutions with JRNET 1 and 563 procedures in 150 institutions with JRNET 2). In total, 790 patients (80.1%) had favourable clinical outcomes defined as modified Rankin Scale (mRS) scores 0–2 at 30 days after embolization. Complete AVM obliteration by embolization alone was achieved in 90 procedures (9.1%). The procedural morbidity and mortality rate was 2.5% and 0.3% per procedure, respectively. In the multivariate logistic regression models, deep venous drainage and embolization of four or more feeding pedicles per session were significantly associated with any treatment-related complications (P = 0.02 and P = 0.003, respectively). About 6 cm or more in maximum nidus diameter had a negative correlation with complications (P = 0.003). Our study shows that embolization of cerebral AVMs was performed with a high degree of safety and a low rate of symptomatic complications in Japan.
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  • Epidemiology of Dural Arteriovenous Fistula in Japan: Analysis of Japanese Registry of Neuroendovascular Therapy (JR-NET2)
    Masafumi HIRAMATSU, Kenji SUGIU, Tomohito HISHIKAWA, Jun HARUMA, Koji ...
    2014 Volume 54 Issue 1 Pages 63-71
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: December 27, 2013
    DOIhttps://doi.org/10.2176/nmc.st.2013-0172
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    We developed the Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) database and used the information for a retrospective, nation-wide multicenter, observational study to clarify the clinical characteristics, current status of procedures, and outcome of patients treated by neuroendovascular therapy in Japan. In this report, we analyzed the clinical characteristics of dural arteriovenous fistulas (dAVFs) in the JR-NET2 database. All patients with dAVFs treated with endovascular therapy in 150 Japanese hospitals were included. Patient characteristics, clinical presentations, and imaging characteristics were analyzed. A total of 1,075 patients with dAVFs underwent 1,520 endovascular procedures. Of 1,075 patients, 45% were men and 55% were women. The mean age was 65 ± 13 years. The most frequent location of dAVFs was the cavernous sinus (43.6%), followed by the transverse-sigmoid sinus (TSS) (33.4%). Twelve percent of the patients had intracranial hemorrhage, 9% had venous infarction, and 3% had convulsion. The statistically significant independent risk factors of intracranial hemorrhage were TSS, superior sagittal sinus (SSS), tentorium, anterior cranial fossa, cranio-cervical junction, cortical venous reflux (CVR), and varix. Risk factors of venous infarction were age older than 60 years, male sex, TSS, SSS, and CVR. Risk factors of convulsion were male sex, SSS, and CVR. This is the largest nationwide report, to date, of the clinical characteristics of dAVFs treated by neuroendovascular therapy. CVR was a major risk factor of aggressive symptoms.
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  • Endovascular Treatment of Spinal Vascular Lesion in Japan: Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET2
    Wataro TSURUTA, Yuji MATSUMARU, Shigeru MIYACHI, Nobuyuki SAKAI
    2014 Volume 54 Issue 1 Pages 72-78
    Published: 2014
    Released on J-STAGE: January 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0201
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    A subgroup analysis of spinal vascular lesions in the Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET2, retrospective registry studies conducted in 2005–2009, was performed to understand the current status of treatment in Japan. Of 201 spinal lesions enrolled, 98 analyzable cases of spinal dural arteriovenous fistula (SDAVF), 43 of spinal perimedullary arteriovenous fistula (SPAVF), and 23 of spinal intramedullary arteriovenous malformation (SIAVM) were assessed. Treatment was radical in the majority (83.6%) of SDAVF, palliative in the majority (70.6%) of SIAVM, and radical and palliative in a similar number of cases of SPAVF. Total occlusion was achieved in 26 (54.2%) SDAVF cases, 9 (29.0%) SPAVF, and 4 (23.5%) SIAVM. Treatment-related complications occurred in 3 (3.1%) SDAVF cases, 7 (16.3%) SPAVF, and 1 (4.3%) SIAVM. Post-treatment neurological improvement was achieved in 49 (50.0%) of SDAVF cases, 15 (34.9%) SPAVF, and 5 (21.7%) SIAVM. The modified Rankin Scale (mRS) of 0, 1, or 2 on postoperative day 30, the primary endpoint, was achieved in 62 (63.3%) SDAVF cases, 26 (60.5%) SPAVF, and 12 (52.2%) SIAVM. The mRS of 0–2 on postoperative day 30 was correlated with presymptomatic mRS of 0–2 [P < 0.0001, odds ratio (OR): 42.88, 95% confidence interval (CI): 14.83–123.97] and postoperative neurological improvement (P = 0.046, OR: 2.57, 95% CI: 1.02–6.48). In Japan, endovascular treatment of spinal vascular lesions was administered safely. Good mRS on postoperative day 30 was highly correlated with good pre-symptomatic mRS, suggesting necessity of early diagnosis and treatment.
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