Related Experiment Video
Updated: May 29, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Carotid artery stenting, what can be learned after more than 1,000 patients: a single centre single operator
Klaudija Bijuklic1, Thilo Tübler, Andreas Wandler
1Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Germany.
Insights
Carotid artery stenting (CAS) by experienced operators in high-volume centers yields low complication rates. Factors like patient anatomy and procedural details influence outcomes, with a learning curve observed within the first 500 procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Carotid endarterectomy (CEA) and carotid artery stenting (CAS) results are debated.
- Interventionist experience is a critical factor in CAS outcomes.
- The learning curve for CAS procedures is not well-defined.
Purpose of the Study:
- To assess CAS outcomes at a high-volume center with a single operator.
- To identify factors contributing to CAS complications.
- To analyze the learning curve for CAS.
Main Methods:
- Retrospective analysis of 1,004 patients undergoing CAS from May 1997 to April 2010.
- Mandatory use of cerebral protection devices since 2000.
- In-hospital complications defined as death, myocardial infarction, or stroke.
Main Results:
- Procedural success rate was 97.77%.
- Perioperative complication rate was 1.69% (0.2% deaths, 1.1% minor stroke, 0.4% major stroke).
- Complications were linked to unfavorable anatomy/procedures (88%) and higher in patients ≥80 years. Rates decreased from 3% to 1% after 500 procedures.
Conclusions:
- CAS in experienced, high-volume settings demonstrates low complication rates.
- Complications are often associated with specific patient/procedural factors and may be preventable.
- A learning curve of up to 500 procedures was observed, and elderly patients face higher risks.
Aims:
The aim of the present study was to evaluate the outcome of carotid artery stenting (CAS) in a single, high-volume centre of a single operator and to analyse the circumstances under which complications occur. Recent trials comparing CAS with carotid endarterectomy demonstrated controversial results. The low experience of interventionists in performing CAS was a major limitation of these studies. The number of procedures needed to achieve optimal skills is unknown.
Methods And Results:
From May 1997 until April 2010, 1,004 patients with symptomatic or asymptomatic carotid artery stenosis underwent CAS by a single operator. A cerebral protection device was in mandatory use since 2000. In-hospital complication rates were defined as the cumulative rate of death, myocardial infarction or stroke. Procedural success was achieved in 97.77% of patients. The perioperative complication rate was 1.69% including 0.2% deaths, 1.1% patients with minor stroke, 0.4% patients with major stroke. In 88% (15 out of 17) of the patients with complications, unfavourable anatomical or procedural factors could be identified. After the first 100 CAS performed,the complication rate was at 3% and significantly decreased to 1% after more than 500 procedures. Patients ≥80 years had a significantly higher complication rate.
Conclusions:
In a high-volume experienced centre, the in-hospital complication rate is low. Complications occurred almost exclusively in patients with unfavourable anatomical or procedural characteristics and seem to be avoidable in most patients. A learning curve was observed up to 500 procedures. Elderly patients have a higher complication rate.