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Catheter in Japan

Catheter is a tube-like instrument that can be inserted into body, and is the focal point of the modern interventional cardiology.

Process of inserting the catheter in body is called catheterization, and used for investigational and interventional purposes in coronary arteries. Catheterization is used for the following methods of cardiac treatments.

  • Angioplasty
  • Angiography
  • Balloon Septostomy

Therapeutic catheterization of coronary arteries is called Percutaneous Coronary Intervention (PCI), or Coronary Angioplasty, treatment on the narrowed (stenotic) coronary arteries.

Angiography is the medical imaging method through the Fluroscopy injecting a radio-opaque contrast agent into the blood vessel. Visualization of coronary artery by angiography serves investigational uses of catheter in heart disease.

Balloon Septostomy is used for the widening of a foramen ovale to treat atrial septal defect (ASD), or congenital heart defect (CHD).

Clinical Application

  • Defect in Patent foramen ovale (PFO)
  • Atrial septal defect (ASD)
  • Cyanotic Congenital Heart Defect (CHD)
  • Coronary Artery Disease (CAD)
  • Valvular Heart Disease (VHD)
  • Ischemic Heart Disease (IHD) or myocardial ischaemia
  • Cardiomyopathy
  • Varicose Veins (Aching, heavy legs, incompetent refluxing perforating veins)

For investigational application, catheterization is used to:

  • Identify the presence of heart ailment
  • Find the cause of a symptom such as shortness of breath, chest pain, cough, wheezing, swelling of the feet, ankles, and legs, etc.
  • Identify the sign of heart insufficiency such as hypertension, heart valve disorders, arrhythmias, and cardiomyopathy

Catheter Devices used in Japan 

Numerous devices related to the catheter were developed and clinically applied in Japan. Some of the devices require highly complex operations, and the treatments are usually not available outside Japan.

  • Stent Catheter

  • Laser Catheter

  • Corsair Catheter

  • Radiofrequency Catheter (e.g., VNUS Closure)

  • IVUS Catheter

  • Doppler Catheter

  • Pressure / Temprature measurement Catheter

  • Catheter with Clot and Grinding / Removal Devices

Endovenous Thermal Ablation on varicose veins

In Japan, traditional vein stripping and surgery is being replaced by laser, radiofrequency ablation, and sclerotherapy.

  • Radiofrequency ablation (RFA, through great / small saphenous vein)
  • Endovenous laser treatment (ELT)

Cardiac Catheteriazation in Japanese hospitals

Number of hospitals in Japan are deemed world-class for cardiac catheterization. A few of the leading hospitals in Japan are listed as below:

  • Chiba Nishi General Hospital
  • Kokura Memorial Hospital

Cost

Type of Catheter Cost
Investigation 240,000 JPY ~
Stent 900,000 JPY ~
Cypher Stent (Drug Eluting) 1,000,000 JPY ~
Rotablator /  PTCA 1,000,000 JPY ~
Rotablator / Stent 1,060,000 JPY ~
Rotablator / Cypher Stent 1,300,000 JPY ~

 Cost is for reference only. Please check with hospitals on the actual costs.

hospital

International Hospital Ranking

Cancer Adoptive Cell Immunotherapy in Japan

Cell based Immunotherapy (Autologous immune enhancement therapy) has been more frequently practised in Japan.Techniques to harvest the cells are extremely intricate and delicate processes. For the treatments to be rountinely available to the cancer patients apart from the clinical trials, advanced engineering cell reprocessing center must be available with good corroboration with the hospitals.

Since Japan made the Immuno-Cell Therapy to be a part of health care systems, the cell processing centers (CPCs) rapidly increased in the past decades. For the therapy of high complexity such as dendritic cell / autologous enhancement immunotherapy to be regularly practiced in the hospital, those CPCs were essential, and this explains why much of innovations in cell based cancer immunotherapy took place in Japan. 

Endoscopic Submucosal Dissection (ESD) \ Endoscopic Mucosal Resection (EMR) in Japan

Both EMR and ESD was originally developed in Japan. EMR / ESD (endoscopic biopsy or polyp resection procedure on gastrointestinal tract) is the area that Japanese surgeons are leading the research at forefront. It is the minimally invasive endoscopic procedure that conserves organs / tissues, and patients can be discharged from the hospital in the same day or a week after the operations. It is usually applicable to early stage cancer / tumor, and improves the post-surgical health conditions such as loss of appetite, fever, chills, pains and life-long medication.

Proton Beam Therapy

Currently there are about 31 proton (or carbon ion) therapy facilities in the world, 8 of which is built in Japan. Proton Beam Therapy is much less invasive than other radiotherapy treatments, and can treat the cancer without incision of the body, and with much less side effects than X-ray treatments. Japan has invested in Proton beam therapy (PBT) / Carbon Ion Therapy infrastructure for a long time, and clinical level studies are numerous and thus well experienced with all kinds of localized tumors.

Radiofrequency Ablation (RFA) on Liver cancer (Hepatocellular carcinoma)

Japan has been leading the RFA intervention technology for a long time, and the yearly number of RFA interventions in Japan currently exceeds that of United States and China. (See the Table below.) Survival rates for the patients undergoing the RFA are not different from those of surgery. But the surgery is harder to be operated multiple times, whereas the RFA is not restricted by the number of interventions or by the presence of Hepatitis.  For this reason, RFA becomes a standard treatment in Japan.

Yearly volume of RFA on Liver Cancer
Japan 34,000
US 14,000
China 9,500

Table: Yearly number of Radiofrequency ablation of Liver or hepatic tumors by country.

Regenerative Medicine on Dilated Cardiomyopathy, or Myocardial Infarction

Recent technological advances in cell sheets engineering extended to the pre-clinical trial of the treatment of heart disease patients often in need for the heart transplant.

Micro-Catheter treatments on varicose veins (including the veins below the knee)

In japan, complex operations towards varicose veins below the knee are established with safey and high response rates. Various catheter and micro-catheter devices are extensively used, and some of them are only available in Japan.

Cancer and Heart Disease Treatment in Japan  

Medical technology in Japan for cancer screening and gastrointestinal diseases are known to be very strong, supported by good clinical statistics, i.e., high five year survival rate after the surgery (or radiology / chemotherapy) among the colon, rectal, stomach, and esophageal cancer patients as well as liver, lung, and larynx cancer (See Table below). 

Since Japanese health agency is notoriously slow and counter-productive when it comes to the approval of new drugs, Japan's hospitals and patients suffered for so long by the technology lag from the rest of the world. Ironically, these regulatory problems lead physicians to the innovations in the fields other than drug discoveries, i.e., in the surgical / laparoscopic, endoscopic, micro-catheter procedures, cell based immunotherapy / vaccinations, radiation (carbon ion and proton beam), and regenerative medicine (iPS cells, cell sheets).

Since the Japanese physicians had less options in chemotherapy, they had more opportunities in experiencing difficult surgeries, and tried the new treatments due to the low availability of new drugs. Thus, many exotic and unique medical technologies emerged out of the isolations casued by the incompetence of Japanese health agency.

Site (Survival Rate:  %)

7 Cancer Registrates in Japan

 US SEER Program Eurocare-3
Esophagus 25 14 10
Stomach 58 22 23
Colon 66 62 51
Rectum 63 63 48
Liver 17 7 7
Gallbladder 18 16 12
Pancreas 6 4 4
Larynx 77 65 62
Lung, bronchus 20 15 11