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Updated: May 18, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Initial results of carotid artery stenting in Japan
Yuji Ikari1, Kazuo Misumi, Hiroyoshi Yokoi
1Department of Cardiovascular Medicine, Tokai University Hospital, 143 Shimokasuya Isehara, Kanagawa, Japan. ikari@is.icc.u-tokai.ac.jp
Insights
Carotid artery stenting (CAS) in Japan showed acceptable initial results. The CASCARD registry found major adverse events were low, demonstrating safety for both symptomatic and asymptomatic patients undergoing this procedure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology Assessment
Background:
- Carotid artery stenting (CAS) gained government approval and reimbursement in Japan in 2008.
- The CASCARD study was initiated to evaluate the early outcomes of CAS in Japan.
- CAS is indicated for patients with high surgical risk or significant carotid artery stenosis.
Purpose of the Study:
- To assess the initial clinical results of carotid artery stenting (CAS) in Japan.
- To evaluate the safety and efficacy of CAS in a real-world Japanese patient cohort.
- To determine the rate of major adverse events following CAS procedures.
Main Methods:
- Retrospective registry study involving 704 CAS cases from 55 Japanese centers (April 2008 - March 2010).
- Inclusion criteria: symptomatic (>50% stenosis) or asymptomatic (>80% stenosis) patients with high-risk factors for carotid endarterectomy.
- Primary endpoint: 30-day major adverse events (MAE) including death, myocardial infarction, and stroke. Angioguard filter wire was the sole protection device used.
Main Results:
- Successful stent implantation in all cases; Angioguard filter wire achieved 99.6% success.
- 30-day MAE rate was 3.7% (0.3% death, 0% MI, 3.4% stroke).
- Major ipsilateral stroke rate was 0.4%. 30-day death or any stroke rate was 2.7% in asymptomatic and 5.5% in symptomatic patients.
Conclusions:
- The CASCARD study demonstrates that initial results of carotid artery stenting in Japan are acceptable.
- CAS is a safe and effective treatment option for both symptomatic and asymptomatic patients in the Japanese population.
- The findings support the adoption and continued use of CAS in Japan for appropriate patient indications.
Abstract:
Carotid artery stenting (CAS) was approved by the government and reimbursement was started in 2008 in Japan, probably the last country in the world. CASCARD is a retrospective registry study performed by cardiologists to assess initial results of CAS in Japan. CAS was indicated for patients with at least one high risk factor for carotid endarterectomy and with >50 % stenosis in symptomatic or >80 % stenosis in asymptomatic patients. Primary endpoint was major adverse events (MAE) including death, myocardial infarction and any stroke at 30 days. Between April 2008 and March 2010, a total of 704 cases were enrolled from 55 centers. The study population with an average age of 74 ± 8 years included 62 % asymptomatic patients, with 23 % of cases with contralateral carotid artery occlusion or significant stenoses. Angioguard filter wire was exclusively used as a primary protection device and successfully passed the lesion in 701 cases (99.6 %). Precise stent was implanted successfully in all cases. MAE at 30 days was 3.7:0.3 % death, 0 % myocardial infarction, and 3.4 % stroke (0.4 % major ipsilateral stroke). Death or any stroke rate at 30 days was 2.7 % in asymptomatic and 5.5 % in symptomatic patients. The CASCARD study showed that the initial results of CAS in Japan are acceptable for both symptomatic and asymptomatic cases.