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Can experienced physicians with high peripheral interventional volume but low carotid artery stenting (CAS) volume
M Rizwan Khalid1, Fatima Khalid, F Ali Farooqui
1Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Insights
Experienced physicians performing carotid artery stenting (CAS) have low complication rates. This study found low complication rates for CAS even with lower CAS volumes, provided the physician has high peripheral interventional experience.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- High-volume carotid artery stenting (CAS) physicians report low complication rates, including cerebrovascular accidents (CVA).
- Complication rates for physicians with low CAS volume (<50/yr) but high peripheral endovascular procedure volume are unknown.
- CAS techniques share similarities with other peripheral interventions.
Purpose of the Study:
- To investigate complication rates in CAS procedures performed by an experienced physician with a high volume of other peripheral endovascular procedures but a low CAS volume.
- To test the hypothesis that high-volume peripheral interventional operators with appropriate training achieve low complication rates during CAS.
Main Methods:
- A retrospective review of CAS procedures performed between 2004-2009 by a single experienced physician with high peripheral interventional volume (>250/yr).
- Use of filter-based embolic protection devices in all CAS procedures.
- 30-day follow-up for major adverse cardiac and cerebral events (MACCE).
Main Results:
- Ninety-two patients (95 lesions) underwent CAS; 50% for recent CVA, 50% for asymptomatic high-grade stenosis.
- All procedures were technically successful. One patient (1.1%) experienced transient ischemic attack (TIA) with full recovery.
- No major strokes occurred; the 30-day MACCE rate was 1.1%.
Conclusions:
- CAS with embolic protection can be performed with very low complication rates by experienced physicians.
- High volume in other peripheral interventions may correlate with low CAS complication rates, even with lower CAS-specific volumes.
- This suggests that broad interventional experience is a key factor in achieving favorable CAS outcomes.
Aims:
It has been stated that experienced physicians with a high volume of carotid artery stent (CAS) procedures have low complication rates, including cerebrovascular accidents (CVA). Complication rates, however, are not known for physicians with a low volume of CAS (<50 CAS/yr) but with a high volume of other peripheral endovascular procedures. Since the techniques used in CAS are similar to those used routinely in other peripheral interventions, we hypothesise that high volume peripheral interventional operators with appropriate training would have low complication rates during CAS procedures.
Methods And Results:
We reviewed all CAS procedures that were performed from 2004-2009 by an experienced physician with a high peripheral interventional volume (>250 interventions/year). Filter-based embolic protection devices were used during each CAS procedure. Each patient was followed for 30 days and data on major adverse cardiac and cerebral events (MACCE) collected. Ninety-two patients with ninety-five lesions were treated with CAS. Recent CVA was the indication in half of the patients and asymptomatic high-grade stenosis was the indication in the other half. Twenty-one (23%) patients had previous history of CEA and six (7%) patients had previous CAS in the contralateral side. All CAS procedures were technically successful. One patient (1.1%) had a TIA with total resolution of symptoms in ten minutes. There were no major strokes. MACCE rate was 1.1% at 30 days.
Conclusions:
We found a very low complication rate following CAS with embolic protection performed by an experienced physician who has a relatively low CAS volume but a high volume of other peripheral interventions.
