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Proctorship for CAS training: a pilot study of safety and reproducibility
A Cappelli1, E Chisci, F Setacci
1Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
The Journal of Cardiovascular Surgery
|January 13, 2011
Summary
A proctorship program improved carotid artery stenting (CAS) outcomes during the learning-curve phase (LCP). This structured training method demonstrated safety and reproducibility, with high procedural success rates and low complication rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Education
Background:
- High complication rates are frequently reported for carotid artery stenting (CAS) during the learning-curve phase (LCP).
- Developing effective training methods is crucial for improving CAS outcomes and patient safety.
- Standardization of procedures and patient selection are key factors in successful CAS.
Purpose of the Study:
- To introduce and evaluate a simple, reproducible proctorship program designed to enhance CAS results during the LCP.
- To assess the safety and efficacy of a structured training approach for vascular surgeons performing CAS.
- To analyze complication rates and procedural success during the implementation of the proctorship program.
Main Methods:
- A four-phase proctorship program was implemented over 30 months, involving a qualified vascular surgeon and four trainee surgeons.
- The program progressed from direct proctor assistance to independent trainee performance, with specific case numbers defining each phase.
- Inclusion criteria focused on carotid stenosis ≥70%, with initial patient selection based on specific characteristics. The CAS procedure was standardized.
Main Results:
- A total of 604 CAS procedures were performed by four trainees, achieving an overall procedural success rate of 98.8%.
- The 30-day complication rates included TIA (1.7%), myocardial infarction (0.8%), minor stroke (1.2%), major stroke (0.64%), and fatal stroke (0.3%).
- A significant decrease in proctor intervention was observed between phases, and complication rates showed a consistent trend across trainees and centers.
Conclusions:
- The implemented proctorship program, combined with patient selection and procedural standardization, appears to be a safe and reproducible method for improving CAS outcomes during the LCP.
- This preliminary experience suggests that structured training can effectively reduce complications and enhance procedural success.
- Further randomized studies are recommended to compare different CAS training techniques and validate these findings.
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