Related Experiment Video
Updated: May 10, 2026
Simulator Training for Endovascular Neurosurgery
Published on: May 6, 2020
Learning curve for intracranial angioplasty and stenting in single center
Qiankun Cai1, Yongkun Li, Gelin Xu
1Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China.
Insights
Determining the learning curve for Intracranial Angioplasty and Stenting (IAS) is crucial for patient safety. This study found that 21 cases were sufficient to overcome the learning curve effect and reduce complications in IAS procedures.
Area of Science:
- Neurosurgery
- Interventional Neurology
- Vascular Neurology
Background:
- The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis trial highlighted high complication rates in endovascular treatment.
- Data on the learning curve for Intracranial Angioplasty and Stenting (IAS) are lacking.
- Establishing the necessary caseload to mitigate the learning effect in IAS is essential for improving patient outcomes.
Purpose of the Study:
- To determine the specific caseload required to overcome the learning curve effect for Intracranial Angioplasty and Stenting (IAS).
- To analyze periprocedural complication rates in relation to operator experience during IAS procedures.
Main Methods:
- Retrospective analysis of 188 consecutive patients (194 lesions) undergoing IAS between March 2004 and May 2012.
- Assessment of learning curve using periprocedural complications (TIA, stroke, vessel rupture, hyperperfusion syndrome, perforation).
- Multivariable logistic regression and risk-adjusted cumulative sum (CUSUM) charts to identify the learning curve threshold.
Main Results:
- The overall 30-day periprocedural complication rate was 12.4% (24/194).
- Operator experience was identified as an independent predictor of periprocedural complications after adjusting for case-mix.
- The learning curve for IAS, in a risk-adjusted manner, was determined to be 21 cases.
Conclusions:
- Operator experience significantly impacts the outcomes of Intracranial Angioplasty and Stenting (IAS).
- A caseload of 21 procedures was found to be sufficient to overcome the learning curve effect for IAS at this center.
- This finding provides a benchmark for training and quality assurance in IAS procedures.
Objective:
To identify the specific caseload to overcome learning curve effect based on data from consecutive patients treated with Intracranial Angioplasty and Stenting (IAS) in our center.
Background:
The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis trial was prematurely terminated owing to the high rate of periprocedural complications in the endovascular arm. To date, there are no data available for determining the essential caseload sufficient to overcome the learning effect and perform IAS with an acceptable level of complications.
Methods:
Between March 2004 and May 2012, 188 consecutive patients with 194 lesions who underwent IAS were analyzed retrospectively. The outcome variables used to assess the learning curve were periprocedural complications (included transient ischemic attack, ischemic stroke, vessel rupture, cerebral hyperperfusion syndrome, and vessel perforation). Multivariable logistic regression analysis was employed to illustrate the existence of learning curve effect on IAS. A risk-adjusted cumulative sum chart was performed to identify the specific caseload to overcome learning curve effect.
Results:
The overall rate of 30-days periprocedural complications was 12.4% (24/194). After adjusting for case-mix, multivariate logistic regression analysis showed that operator experience was an independent predictor for periprocedural complications. The learning curve of IAS to overcome complications in a risk-adjusted manner was 21 cases.
Conclusions:
Operator's level of experience significantly affected the outcome of IAS. Moreover, we observed that the amount of experience sufficient for performing IAS in our center was 21 cases.
