[Carotid artery stenting: is there a volume-outcome correlation?]

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Carotid artery stenting (CAS) emerged as an alternative to carotid endarterectomy for significant carotid artery stenosis.
• Published randomized trials exhibit varied event rates, influenced by differing proceduralist experience minimums.

Purpose of the Study:

• To analyze the impact of interventionalist experience on carotid artery stenting outcomes.
• To compare the safety and efficacy of CAS versus surgical intervention based on proceduralist experience.

Main Methods:

• Review of randomized trials and large single-center studies/registries on carotid artery stenting.
• Analysis of event rates correlated with the number of prior carotid artery interventions performed by the treating physician.

Main Results:

• Large single-center studies and registries demonstrate a significant reduction in event rates with increased operator experience in CAS.
• Randomized trials with stringent experience requirements show comparable outcomes between CAS and surgical approaches.

Conclusions:

• Proceduralist experience is a critical factor in reducing event rates associated with carotid artery stenting.
• CAS is a viable alternative to surgery for carotid artery stenosis when performed by experienced interventionalists, as evidenced by randomized trial data.