Background And Purpose: Randomized clinical trials show higher 30-day risk of stroke or death after carotid artery stenting compared with surgery. We examined whether operator experience is associated with 30-day risk of stroke or death in the Carotid Stenting Trialists' Collaboration database.
Methods: The Carotid Stenting Trialists' Collaboration is a pooled individual patient database including all patients recruited in 3 randomized trials of stenting versus endarterectomy for symptomatic carotid stenosis (Endarterectomy Versus Angioplasty in patients with Symptomatic Severe Carotid Stenosis trial, Stent-Protected Angioplasty versus Carotid Endarterectomy trial, and International Carotid Stenting Study). Lifetime carotid artery stenting experience, lifetime experience in stenting procedures excluding the carotid, and annual number of procedures performed within the trial (in-trial volume), divided into tertiles, were used to measure operator experience. The outcome event was the occurrence of any stroke or death within 30 days of the procedure. The analysis was done per protocol.
Results: Among 1546 patients who underwent carotid artery stenting, 120 (7.8%) had a stroke or death within 30 days of the procedure. The 30-day risk of stroke or death did not differ according to operator lifetime carotid artery stenting experience (P=0.8) or operator lifetime stenting experience excluding the carotid (P=0.7). In contrast, the 30-day risk of stroke or death was significantly higher in patients treated by operators with low (mean ≤3.2 procedures/y; risk 10.1%; adjusted risk ratio=2.30 [1.36-3.87]) and intermediate annual in-trial volumes (3.2-5.6 procedures/y; 8.4%; adjusted risk ratio=1.93 [1.14-3.27]) compared with patients treated by high annual in-trial volume operators (>5.6 procedures/y; 5.1%).
Conclusions: Carotid stenting should only be performed by operators with annual procedure volume ≥6 cases per year.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1161/STROKEAHA.113.003526 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Higher Rate of Reinterventions After Transfemoral Carotid Artery Stenting in Symptomatic Patients: A Retrospective Stroke Center's Cohort Study between 2015-2024.
Ann Vasc Surg
January 2025
Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL. Electronic address:
Introduction: Carotid artery stenosis is a significant contributor to ischemic strokes, and its surgical management includes carotid artery endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and trans carotid artery revascularization (TCAR). CEA has traditionally been preferred, but TF-CAS and TCAR are also excellent alternative options if the anatomy of the vessels allows them. This study reports our short- and mid-term outcomes after carotid artery revascularization in symptomatic patients at a stroke center.
View Article and Find Full Text PDFSurgical outcomes of subclavian steal syndrome combined with carotid artery stenosis: A single-center retrospective observational study.
Sci Prog
January 2025
Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
Objective: To explore the prevalence and risk factors of carotid artery (CA) stenosis among subclavian steal syndrome (SSS) patients and to record their prognoses.
Methods: This observational study was retrospective. From January 2015 to October 2022, 169 patients were diagnosed with SSS.
Evaluation of in-stent restenosis after carotid artery stenting with superb microvascular imaging: initial findings.
Acta Radiol
January 2025
Department of Radiology, Interventional Radiology, Sağlık Bilimleri Üniversitesi Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Ankara, Türkiye.
Background: Carotid artery stenting (CAS) is an interventional management in preventing ischemic stroke caused by carotid artery stenosis. After the treatment with CAS, in-stent restenosis caused by neointimal hyperplasia may develop.
Purpose: This study aims to obtain a better determination of neointimal hyperplasia using superb microvascular imaging (SMI), which provides a high-quality visualization of the endoluminal lesions, and to compare these results with B-mode and Doppler ultrasound (US).
An increase in flow-diverter oversizing values as an independent risk factor for developing more severe in-stent stenosis. A retrospective single-center study based on flow diversion of supraclinoid internal carotid artery aneurysms.
Front Neurol
January 2025
Department of Interventional Radiology, University Hospital St. Ivan Rilski, Sofia, Bulgaria.
Introduction: In the past decade, flow diverters (FDs) have increasingly been used to treat cerebral aneurysms with unfavorable morphology in which other endovascular techniques fall short of being as effective. In-stent stenosis (ISS) is one of the most puzzling and frequent risks of flow diversion therapy observed on follow-ups. This complication, although mostly placid in its clinical course, can have dire consequences if patients become symptomatic.
View Article and Find Full Text PDFProximal protection devices for carotid artery stenting - A benchtop assessment of flow reversal performance.
AJNR Am J Neuroradiol
January 2025
From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K), and Department of Neurologic Surgery (Y.C.S., R.K., W.B.), Mayo Clinic, Rochester, MN, United States; Department of Stroke Research (J.L.), Vall d'Hebron Research Institute, Barcelona, Spain; From the Global Institute of Future Technology (Y.L.), Shanghai Jiao Tong University, Shanghai, China; Department of Neurointerventional Radiology (J.C.), Bicetre University Hospital, Le Kremlin Bicetre, France.
Background And Purpose: Proximal protection devices, such as TransCarotid Artery Revascularization (TCAR, SilkRoad Medical, Sunnyvale), aim to yield better outcomes in carotid artery stenting (CAS) than distal protection devices by preventing plaque embolization to the brain. However, transfemoral catheters may not fully reverse flow from the external carotid artery (ECA) to the internal carotid artery (ICA). We assess a new balloon-sheath device, Femoral Flow Reversal Access for Carotid Artery Stenting (FFRACAS), for this purpose.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!