Safety of Carotid Stenting (CAS) is Based on Institutional Training More than Individual Experience in Large-volume Centres

Parlani, Gianbattista; Rango, Paola De; Verzini, Fabio; Cieri, Enrico; Casalino, Alfonso; Manzone, Alessandra; Cao, Piergiorgio

doi:10.1016/j.ejvs.2013.02.003

Cited by 17 publications

(10 citation statements)

References 22 publications

(14 reference statements)

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“…Regarding CAS, there is no consensus on the minimum number of CAS procedures required to define safety 5 nor for maintenance of competency. 21 Moreover, different specialty societies have different elements which define competency.…”

Section: Discussionmentioning

confidence: 99%

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Complication Rates and Center Enrollment Volume in the Carotid Revascularization Endarterectomy Versus Stenting Trial

Gonzales

Demaerschalk

Voeks

et al. 2014

Stroke

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Background and Purpose Evidence indicates that center volume of cases affects outcomes for both carotid endarterectomy (CEA) and stenting (CAS). We evaluated the effect of enrollment volume by site on complication rates in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Methods The primary composite endpoint was any stroke, myocardial infarction, or death within 30 days or ipsilateral stroke in follow-up. The 477 approved surgeons performed >12 procedures per year with complication rates <3% for asymptomatic patients and <5% for symptomatic patients; 224 interventionists were certified after a rigorous two step credentialing process. CREST centers were divided into tertiles based on the number of patients enrolled into the study, with Group 1 sites enrolling <25 patients, Group 2 sites enrolling 25–51 patients and Group 3 sites enrolling >51 patients. Differences in periprocedural event rates for the primary composite endpoint and its components were compared using logistic regression adjusting for age, sex, and symptomatic status within site-volume level. Results The safety of CAS and CEA did not vary by site-volume during the periprocedural period as indicated by occurrence of the primary endpoint (p=0.54) or by stroke and death (p=0.87). A trend towards an inverse relationship between center enrollment volume and complications was mitigated by adjustment for known risk factors. Conclusions Complication rates were low in CREST and were not associated with center enrollment volume. The data are consistent with the value of rigorous training and credentialing in trials evaluating endovascular devices and surgical procedures.

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Section: Discussionmentioning

confidence: 99%

“…CAS complication rates may also be related to collective institutional proficiency and experience encompassing factors such as patient selection, device selection, and adjunctive medical management, along with reviews of lessons learnt from collegial reviews of all cases. 5 …”

Section: Introductionmentioning

confidence: 99%

Complication Rates and Center Enrollment Volume in the Carotid Revascularization Endarterectomy Versus Stenting Trial

Gonzales

Demaerschalk

Voeks

et al. 2014

Stroke

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show abstract

“…Second, operator volume was not available in this study because of the limitation of NHIRD. Hospital volume, however, may be more important than operator volume, as shown in a prior study . Third, the accurate definition for ischemic stroke and ICH cannot be fully validated during the periprocedural period.…”

Section: Discussionmentioning

confidence: 99%

Impact of hospital volume on long‐term neurological outcome in patients undergoing carotid artery stenting

Hung

Yeh

Lin

et al. 2017

Cathet Cardio Intervent

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“…Hospital volume, however, may be more important than operator volume, as shown in a prior study [22]. First, the propensity score matching eliminated the heterogeneity between two groups.…”

Section: Discussionmentioning

confidence: 97%

Impact of Hospital Volume on Long‐Term Neurological Outcome in Patients Undergoing Carotid Artery Stenting: A Nationwide Propensity Score‐Matched Study. DOI: 10.1002/ccd.26989

Hung¹,

Yeh²,

Lin³

et al. 2017

Cathet Cardio Intervent

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Safety of Carotid Stenting (CAS) is Based on Institutional Training More than Individual Experience in Large-volume Centres

Abstract: Institutional experience, including instruction on selection of patients and materials best suited for the procedure, is a primary factor driving outcomes of CAS. An effective team-working approach can reliably improve the training of new trainees preserving CAS safety and efficacy.

Cited by 17 publications

References 22 publications

Complication Rates and Center Enrollment Volume in the Carotid Revascularization Endarterectomy Versus Stenting Trial

Complication Rates and Center Enrollment Volume in the Carotid Revascularization Endarterectomy Versus Stenting Trial

Impact of hospital volume on long‐term neurological outcome in patients undergoing carotid artery stenting

Impact of Hospital Volume on Long‐Term Neurological Outcome in Patients Undergoing Carotid Artery Stenting: A Nationwide Propensity Score‐Matched Study. DOI: 10.1002/ccd.26989

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