Tokuda Ryo, Yoshimura Shinichi, Uchida Kazutaka, Yamada Kiyofumi, Satow Tetsu, Iihara Koji, Sakai Nobuyuki
Department of Neurosurgery, Hyogo College of Medicine.
Department of Neurosurgery, National Cerebral and Cardiovascular Center.
Neurol Med Chir (Tokyo). 2019 Apr 15;59(4):117-125. doi: 10.2176/nmc.st.2018-0264. Epub 2019 Mar 15.
We aimed to clarify the outcomes of carotid artery stenting (CAS) in the Japanese population. For this purpose, we reviewed data from the Japanese Registry of NeuroEndovascular Therapy 3 (JR-NET3), a retrospective, nation-wide, multi-center, observational study of neuroendovascular treatments in Japan. Of the 9207 patients who underwent CAS between January 2010 and December 2014, 8458 satisfied the inclusion criteria for our analysis. The outcome statistics of this JR-NET3 cohort were compared to those of JR-NET1 and 2 cohorts fitting the same inclusion criteria. Of the 8458 JR-NET3 patients analyzed, 8042 (95.1%) were treated by surgeons with board certification from the Japanese Society for NeuroEndovascular Therapy. Technical success was achieved in 8417 patients (99.5%), whereas 198 patients (2.3%) had clinically significant complications (CSCs). These findings mirrored those obtained for the JR-NET1 and 2 cohorts. On multivariate analysis, risk factors for CAS-associated CSC included symptomatic lesion [odds ratio (OR), 1.91; 95% confidence interval (CI), 1.23-3.00; P = 0.003] and hypoechoic lesion on carotid artery ultrasound (OR, 1.85; 95% CI, 1.21-2.84; P = 0.005), whereas use of closed-cell stents was a predictor of better outcome (OR, 0.53; 95% CI, 0.35-0.79; P = 0.002). The findings of JR-NET3 reflect good outcomes of CAS, but non-modifiable risk factors reflecting lesion characteristics remain of concern. Using closed-cell stents is advisable. Technological advances such as the introduction of new materials may help further improve CAS outcomes in Japanese patients.
我们旨在阐明日本人群中颈动脉支架置入术（CAS）的治疗结果。为此，我们回顾了来自日本神经血管内治疗注册研究3（JR-NET3）的数据，这是一项在日本进行的回顾性、全国性、多中心的神经血管内治疗观察性研究。在2010年1月至2014年12月期间接受CAS治疗的9207例患者中，8458例符合我们分析的纳入标准。将JR-NET3队列的结果统计数据与符合相同纳入标准的JR-NET1和2队列的结果进行比较。在分析的8458例JR-NET3患者中，8042例（95.1%）由获得日本神经血管内治疗学会认证的外科医生进行治疗。8417例患者（99.5%）技术成功，而198例患者（2.3%）出现临床显著并发症（CSC）。这些结果与JR-NET1和2队列的结果相似。多因素分析显示，与CAS相关的CSC的危险因素包括症状性病变[比值比（OR），1.91；95%置信区间（CI），1.23 - 3.00；P = 0.003]和颈动脉超声低回声病变（OR，1.85；95%CI，1.21 - 2.84；P = 0.005），而使用闭孔支架是预后较好的预测因素（OR，0.53；95%CI，0.35 - 0.79；P = 0.002）。JR-NET3的研究结果反映了CAS的良好疗效，但反映病变特征的不可改变的危险因素仍值得关注。建议使用闭孔支架。新材料的引入等技术进步可能有助于进一步改善日本患者的CAS治疗效果。
