Gianbattista Parlani1, Paola De Rango1, Fabio Verzini1, Enrico Cieri1, Gioele Simonte1, Piergiorgio Cao2
1Vascular and Endovascular Surgery; University of Perugia, Perugia, Italy; 2Vascular Surgery, Hospital S.Camillo Forlanini, Rome, Italy.
OBJECTIVES: Relevance of training has been recognized as a key factor for safety of Carotid stenting (CAS).
The objective of this study was to evaluate whether the center learning curve could shortcut the training of new trainees with CAS.
METHODS: Consecutive CAS procedures performed from 2001 to 2010 were reviewed. The learning curve phase (years 2001-2003) was performed by the “leader team” (“historical team”) including vascular surgeons and interventional radiologists who first approached CAS. Learning curve included acquisition of handle skill with CAS procedural steps and best selection of patients and materials. Periprocedural complications after the learning curve in the “leader team phase” (the historical team continued to perform all procedures in 2004-2006) and in the “expanded team phase” (5 new trainees joined the historical team in 2006-2010) were measured.
RESULTS: A total of 1,540 CAS were reviewed. The first 195 represented the learning curve. Of the remaining 1,345 CAS, 431 were performed in the “leader phase” and 914 in the “expanded team phase”. Individual operator volume for the new trainees ranged from 20 to 188 CAS. Periprocedural complications were similarly low in the two phases: strokes (2.8% vs. 2.2%; p=0.56) major strokes (0.9% vs. 0.8%, p=0.75), death (0.2% vs. 0%; p=0.3) for the leader and expanded team phase respectively. Mean procedure time was longer (43 min vs. 38 min) in the expanded team phase, while rates of immediate conversions (1.0% vs. 3.5%, p=0.03) and mean contrast use (69 mL vs. 92 mL; p<0.0001) decreased.
CONCLUSIONS: The primary factor driving stroke reduction with CAS is the center experience. CAS complication
rate is not based on individual rules but most likely on the center/team practice also defining how to select patients and materials best suited for the procedure. Appropriate learning curve of the center can reliably shortcut the training of new trainees preserving CAS safety and efficacy.
AUTHOR DISCLOSURES: P. Cao, Nothing to disclose; E. Cieri, Nothing to disclose; P. De Rango, Nothing to disclose; G. Parlani, Nothing to disclose; G. Simonte, Nothing to disclose; F. Verzini, Nothing to disclose.
Posted April 2012