Carotid artery stenting, what can be learned after more than 1,000 patients: a single centre single operator experience
| Autor: | Heinrich Goossens-Merkt, Thilo Tübler, Joachim Schofer, Andreas Wandler, Klaudija Bijuklic |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Myocardial Infarction Carotid endarterectomy Risk Assessment Severity of Illness Index Recurrence Risk Factors Germany Angioplasty Severity of illness medicine Humans Carotid Stenosis Hospital Mortality Myocardial infarction Stroke Aged Retrospective Studies Aged 80 and over Chi-Square Distribution business.industry Patient Selection Age Factors Retrospective cohort study Perioperative Middle Aged medicine.disease Surgery Radiography Logistic Models Treatment Outcome Multivariate Analysis Female Stents Clinical Competence Cardiology and Cardiovascular Medicine Complication business Learning Curve |
| Zdroj: | EuroIntervention. 7:820-827 |
| ISSN: | 1774-024X |
| DOI: | 10.4244/eijv7i7a129 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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