Learning curve for intracranial angioplasty and stenting in single center

Cai, Qiankun; Xu, Gelin; Sun, Wen; Xiong, Yunyun; Sun, Wei; Bao, Yong-Rui; Huang, Xianjun; Zhang, Yao; Zhou, Lulu; Zhu, Wusheng; Liu, Xinfeng

doi:10.1002/ccd.25038

Cited by 17 publications

(17 citation statements)

References 26 publications

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“…In this review, we witnessed a more intuitive-looking variation of the original CUSUM failure chart, the cumulative observed minus expected failure chart, formulated by Novick et al [4] to investigate LCs in OPCAB. Another variation, which overcame the failure of Novick et al's chart to compensate for the assorted cases was the risk-adjusted CUSUM curve that enlisted patient-specific risk of failure rather than common expected failure rate and was used in various vascular and valvular surgery LC studies [22,40].…”

Section: Methods and Statistical Analysismentioning

confidence: 99%

“…Researchers also used the CUSUM analysis at an institutional level in their retrospective analyses and investigated LCs of a group of surgeons to determine whether the examined treatment center was achieving the desirable patient outcomes [36,39,40].…”

Section: Methods and Statistical Analysismentioning

confidence: 99%

“…Cai et al [40] explored LCs for intracranial angioplasty and stenting using retrospective analysis of 188 patients. The LC to overcome procedure's complications was 21 cases and operator experience was found to be an independent predictor for complications.…”

Section: Vascular Surgerymentioning

confidence: 99%

“…Based on OT, which was the most common variable measured, the LC for CABG which included on-pump and offpump approaches ranged between 15 and 100 cases [4][5][6][7][8][9][10][11][12][13][14]; for endoscopic vessel harvesting, LCs lied between 20 and 35 cases [15,16]; for valvular surgery, which included valvular repair and valve replacement surgeries, LC were found to be between 20 and 135 cases [17][18][19][20][21][22][23][24][25][26][27]; for VATS, LCs were between 15 and 35 cases [28][29][30][31][32]; for vascular neurosurgical procedures, LCs were computed to be between 100 and 500 cases based on complications [37][38][39][40]; for endovascular vessel repairs, LCs were between 5 and 40 cases DOI: 10.1080/00325481.2014.996113…”

Section: Summary Of Findingsmentioning

confidence: 99%

See 3 more Smart Citations

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Arora

Khan

Abboudi

et al. 2014

Postgraduate Medicine

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LCs in cardiothoracic and vascular procedures are hugely variable depending on the procedure type, outcome measures, level of prior experience, and methods/statistics used. Uniformity in methods, variables, and statistical analysis is needed to derive meaningful comparisons of LCs. Acknowledgment and application of learning processes other than those reliant on volume-outcomes relationship will benefit LC research and training of surgeons.

show abstract

Section: Methods and Statistical Analysismentioning

confidence: 99%

Section: Methods and Statistical Analysismentioning

confidence: 99%

Section: Vascular Surgerymentioning

confidence: 99%

Section: Summary Of Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Arora

Khan

Abboudi

et al. 2014

Postgraduate Medicine

View full text Add to dashboard Cite

show abstract

“…The operator learning curve for the Angiojet© catheter has been studied, and even the use of Angiojet© thrombectomy for venous thrombosis is well established . One study of the learning curve for intracranial angioplasty and stenting procedures at a single medical center found that the operator's experience level was an independent predictor for periprocedural complications . The study found that, at least at the relevant medical center, 21 cases were sufficient experience for performing intracranial angioplasty and stenting.…”

Section: Introductionmentioning

confidence: 99%

Survival analysis of hierarchical learning curves in assessment of cardiac device and procedural safety

Govindarajulu

Bedi

Kluger

et al. 2018

Statistics in Medicine

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Many Americans rely on cardiac surgical procedures and devices such as pacemakers and thrombolytic catheters to treat or manage their cardiovascular diseases. However, the failure of these cardiac devices and procedures could have grave consequences. One reason cardiac devices tended to fail was due to physician error; there is a learning effect for the physician or operator to come up to speed in skillfully implanting devices and conducting procedures. In order to better understand these learning effects, we had previously modeled the resulting learning curve effects in simulations a hierarchical setting with physicians clustered within institutions using our unique methodology (see the work of Govindarajulu et al 2017). Previously, we had employed these in hierarchical linear modeling and also in generalized estimating equations. In this setting, we have demonstrated how to apply similar methodology but revised in a survival analytic framework or time-to-event analyses. Through simulations and real dataset applications, we found that, out of the three shapes modeled to fit the learning curve, the logarithmic shape tended to have the best fit, similar to previous work (see the work of Govindarajulu et al 2017). However, as seen before, modeling the learning rate can be dataset specific and one shape may be better than another. We learned that modeling the learning rate could also be applied in the survival analysis setting through this new methodology. The goal of this paper is to model cardiac device and procedure learning curve effects in a time-to-event setting so that this knowledge may allow for the improvement of both short and long-term patient survival.

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Safety and effect of Neuroform Atlas stent in the treatment of symptomatic intracranial stenosis: A single-center experience

Buonomo

Mormina

Caragliano

et al. 2021

Heliyon

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Background: Vascular intracranial stenosis (IS) is a significant cause of acute ischemic stroke (AIS). This singlecenter study aims to show that symptomatic IS treatment by using the Neuroform Atlas stent (Stryker neurovascular, Kalamazoo, MI, USA) could be effective in reducing vessel stenosis. Methods: Ten patients affected by AIS or TIA, in the vascular territory of high-grade intracranial atherosclerotic lesions (>70% of vessel stenosis), older than 18-year-old, were treated by implanting a Neuroform Atlas stent (diameter of 4.5mm in 80% and 4mm in 20%). 70% of the patients underwent pre-stenting intracranial angioplasty. Results: Patients were between 54.8 and 83 years old (mean 68.46y AE 8.44y), 70% males and 30% females. At admission, 50% of all patients had an AIS and 50% a TIA. Restoration of the stenotic lumen was obtained after the endovascular procedure. The percentage mean of vascular stenosis was 83.7% AE 6.09% before treatment (t0), 52.2% AE 10.42% at the end of treatment (t1) and 46.2% AE 8.28% at the follow-up (t2). The IS percentage mean reduction between t0 and t1 was 31.5% AE 7.31%, and between t1 and t2 was 6% AE 5.47%, t0 and t2 of 37.5% AE 7.38%. Percentage reduction of IS was highly significant between time t0 and t1 (p ¼ 0.005), and t0 and t2 (p ¼ 0.005), also with a significant reduction between t1 and t2 (p ¼ 0.012). No patient had experienced an increase of the ischemic area in the vascular territory of the target vessel at 3 months from the initial assessment. 10% of patients experienced a 3-months negative outcome (mRS ¼ 5), 90% experienced a favorable outcome (mRS 2). Conclusions: Intracranial stenosis endovascular treatment with Neuroform Atlas stent provides encouraging results, with a statistically significant association between the vascular caliber improvement and the endovascular treatment.

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Learning curve for intracranial angioplasty and stenting in single center

Abstract: Operator's level of experience significantly affected the outcome of IAS. Moreover, we observed that the amount of experience sufficient for performing IAS in our center was 21 cases.

Cited by 17 publications

References 26 publications

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Survival analysis of hierarchical learning curves in assessment of cardiac device and procedural safety

Safety and effect of Neuroform Atlas stent in the treatment of symptomatic intracranial stenosis: A single-center experience

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