Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug 15;59(8):305-312.
doi: 10.2176/nmc.oa.2018-0325. Epub 2019 May 25.

Safety and Feasibility of Neuroendovascular Therapy for Elderly Patients: Analysis of Japanese Registry of Neuroendovascular Therapy 3

Koichi Arimura  1 , Koji Iihara  1 , Tetsu Satow  2 , Ataru Nishimura  1 , So Tokunaga  3 , Nobuyuki Sakai  4 ; JR-NET investigators
Affiliations

Safety and Feasibility of Neuroendovascular Therapy for Elderly Patients: Analysis of Japanese Registry of Neuroendovascular Therapy 3

Koichi Arimura et al. Neurol Med Chir (Tokyo). .

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.

Keywords: JR-NET 3; elderly; neuroendovascular therapy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest Disclosure

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.

References

    1. Goyal M, Menon BK, van Zwam WH, et al. : Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387: 1723–1731, 2016 - PubMed
    1. Sturiale CL, Brinjikji W, Murad MH, Lanzino G: Endovascular treatment of intracranial aneurysms in elderly patients: a systematic review and meta-analysis. Stroke 44: 1897–1902, 2013 - PubMed
    1. Wiebers DO, Whisnant JP, Huston J, et al. : Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362: 103–110, 2003 - PubMed
    1. Ryttlefors M, Enblad P, Kerr RS, Molyneux AJ: International subarachnoid aneurysm trial of neurosurgical clipping versus endovascular coiling: subgroup analysis of 278 elderly patients. Stroke 39: 2720–2726, 2008 - PubMed
    1. Howard G, Roubin GS, Jansen O, et al. : Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet 387: 1305–1311, 2016 - PubMed

MeSH terms