Robert D Ecker1, Eric Sauvageau, Elad I Levy, L Nelson Hopkins. 1. Millard Fillmore Gates Hospital, Kaleida Health, Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
Abstract
OBJECTIVE: Among neurosurgeons, cardiologists, neuroradiologists, vascular surgeons, and peripheral vascular radiologists, the metric of clinical competency in carotid artery angioplasty and stenting (CAS) continues to be debated. This review of fellowship experience with more than 200 CAS cases was undertaken to ascertain the 30-day morbidity and mortality rates at a high-volume endovascular training center with a well-established system for teaching CAS. METHODS: A prospectively collected database of more than 8000 endovascular cases was culled for all patients undergoing CAS from July 2004 through February 2006, in which the primary operator was one of the current senior fellows (RDE, ES). The operative reports, hospital charts, and office notes were then reviewed for morbidity and mortality within 30 days. RESULTS: At 30 days, the combined rates of morbidity and mortality for each fellow were nearly identical at 4.9 and 5.9%, respectively. There were two deaths, one of which resulted from reperfusion hemorrhage and one after cardiac surgery. During the study period, six strokes and two myocardial infarctions occurred; one of the patients who had a myocardial infarction underwent coronary stenting on an emergency basis. One patient had a femoral artery occlusion requiring operative repair. CONCLUSION: At a high-volume endovascular training center with a well-established teaching pathway for CAS, morbidity and mortality rates comparable to those reported in previously published series of carotid endarterectomy were obtained.
OBJECTIVE: Among neurosurgeons, cardiologists, neuroradiologists, vascular surgeons, and peripheral vascular radiologists, the metric of clinical competency in carotid artery angioplasty and stenting (CAS) continues to be debated. This review of fellowship experience with more than 200 CAS cases was undertaken to ascertain the 30-day morbidity and mortality rates at a high-volume endovascular training center with a well-established system for teaching CAS. METHODS: A prospectively collected database of more than 8000 endovascular cases was culled for all patients undergoing CAS from July 2004 through February 2006, in which the primary operator was one of the current senior fellows (RDE, ES). The operative reports, hospital charts, and office notes were then reviewed for morbidity and mortality within 30 days. RESULTS: At 30 days, the combined rates of morbidity and mortality for each fellow were nearly identical at 4.9 and 5.9%, respectively. There were two deaths, one of which resulted from reperfusion hemorrhage and one after cardiac surgery. During the study period, six strokes and two myocardial infarctions occurred; one of the patients who had a myocardial infarction underwent coronary stenting on an emergency basis. One patient had a femoral artery occlusion requiring operative repair. CONCLUSION: At a high-volume endovascular training center with a well-established teaching pathway for CAS, morbidity and mortality rates comparable to those reported in previously published series of carotid endarterectomy were obtained.