PURPOSE: Several scientific committees have proposed an accentuation of operator minimal requirements before accreditation for carotid artery stenting is granted. The current study aims to identify potential effects from increasing site experience on periprocedural safety and outcome of carotid artery stenting (CAS). METHODS: Between 1996 and December 2009, 5,535 procedures have been entered into the prospective, controlled ALKK-CAS-Registry. The total cohort was divided in four subgroups according to the consecutive patient order at each participating center: patients 1-49 (n = 1,485), 50-99 (n = 1,118), 100-199 (n = 1,521) and ≥200 (n = 1,411). RESULTS: The median age of all patients was 71 years; 52.8 % had a symptomatic carotid stenosis. A decline in the rates of in-hospital major stroke (2.1, 1.9, 1.6, 0.9, p for trend 0.014) and of ipsilateral strokes (3.1, 2.4, 2.5, 1.6 %, p for trend 0.019) was substantiated with increasing site experience. This significant trend was preserved in the combined rate of major stroke and death (4.0, 3.2, 3.4, 2.4 %, p for trend 0.034). Apart from CAS experience, improvements in CAS technique, a decreasing number of symptomatic patients and an increasing number of procedures under embolic protection (each p for trend <0.05) might have contributed to these results. CONCLUSIONS: The results show a gradual reduction of in-hospital stroke rates with increasing center experience. Extensive supervision of CAS learners and further promotion of proctorship programs seem to be essential.
PURPOSE: Several scientific committees have proposed an accentuation of operator minimal requirements before accreditation for carotid artery stenting is granted. The current study aims to identify potential effects from increasing site experience on periprocedural safety and outcome of carotid artery stenting (CAS). METHODS: Between 1996 and December 2009, 5,535 procedures have been entered into the prospective, controlled ALKK-CAS-Registry. The total cohort was divided in four subgroups according to the consecutive patient order at each participating center: patients 1-49 (n = 1,485), 50-99 (n = 1,118), 100-199 (n = 1,521) and ≥200 (n = 1,411). RESULTS: The median age of all patients was 71 years; 52.8 % had a symptomatic carotid stenosis. A decline in the rates of in-hospital major stroke (2.1, 1.9, 1.6, 0.9, p for trend 0.014) and of ipsilateral strokes (3.1, 2.4, 2.5, 1.6 %, p for trend 0.019) was substantiated with increasing site experience. This significant trend was preserved in the combined rate of major stroke and death (4.0, 3.2, 3.4, 2.4 %, p for trend 0.034). Apart from CAS experience, improvements in CAS technique, a decreasing number of symptomatic patients and an increasing number of procedures under embolic protection (each p for trend <0.05) might have contributed to these results. CONCLUSIONS: The results show a gradual reduction of in-hospital stroke rates with increasing center experience. Extensive supervision of CAS learners and further promotion of proctorship programs seem to be essential.
Authors: G S Roubin; G New; S S Iyer; J J Vitek; N Al-Mubarak; M W Liu; J Yadav; C Gomez; R E Kuntz Journal: Circulation Date: 2001-01-30 Impact factor: 29.690
Authors: William A Gray; Kenneth A Rosenfield; Michael R Jaff; Seemant Chaturvedi; Lei Peng; Patrick Verta Journal: JACC Cardiovasc Interv Date: 2011-02 Impact factor: 11.195
Authors: Alberto Cremonesi; Carlo Setacci; Angelo Bignamini; Leonardo Bolognese; Francesco Briganti; Germano Di Sciascio; Domenico Inzitari; Gaetano Lanza; Luciano Lupattelli; Salvatore Mangiafico; Carlo Pratesi; Bernard Reimers; Stefano Ricci; Gianmarco de Donato; Ugo Ugolotti; Augusto Zaninelli; Gian Franco Gensini Journal: Stroke Date: 2006-08-10 Impact factor: 7.914
Authors: Paul T L Chiam; Gary S Roubin; Georgia Panagopoulos; Sriram S Iyer; Richard M Green; Christina Brennan; Jiri J Vitek Journal: Circulation Date: 2009-04-20 Impact factor: 29.690
Authors: Benjamin M Jackson; Sean J English; Ronald M Fairman; Jagajan Karmacharya; Jeffrey P Carpenter; Edward Y Woo Journal: J Vasc Surg Date: 2008-05-23 Impact factor: 4.268
Authors: Bernhard Reimers; Michael Schlüter; Fausto Castriota; Thilo Tübler; Nicola Corvaja; Carlo Cernetti; Raffaella Manetti; Amedeo Picciolo; Francesco Liistro; Carlo Di Mario; Alberto Cremonesi; Joachim Schofer; Antonio Colombo Journal: Am J Med Date: 2004-02-15 Impact factor: 4.965
Authors: Nicole R Gonzales; Bart M Demaerschalk; Jenifer H Voeks; MeeLee Tom; George Howard; Alice J Sheffet; Lawrence Garcia; Daniel G Clair; John Barr; Steven Orlow; Thomas G Brott Journal: Stroke Date: 2014-09-25 Impact factor: 7.914
Authors: Stephan Staubach; Ralph Hein-Rothweiler; Matthias Hochadel; Manuela Segerer; Ralf Zahn; Jens Jung; Gotthard Riess; Hubert Seggewiss; Andre Schneider; Thomas Fürste; Christian Gottkehaskamp; Harald Mudra Journal: Clin Res Cardiol Date: 2014-01-11 Impact factor: 5.460