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The role of endovascular expertise in carotid artery stenting: results from the ALKK-CAS-Registry in 5,535 patients

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Abstract

Purpose

Several scientific committees have proposed an accentuation of operator minimal requirements before accreditation for carotid artery stenting is granted. The current study aims to identify potential effects from increasing site experience on periprocedural safety and outcome of carotid artery stenting (CAS).

Methods

Between 1996 and December 2009, 5,535 procedures have been entered into the prospective, controlled ALKK-CAS-Registry. The total cohort was divided in four subgroups according to the consecutive patient order at each participating center: patients 1–49 (n = 1,485), 50–99 (n = 1,118), 100–199 (n = 1,521) and ≥200 (n = 1,411).

Results

The median age of all patients was 71 years; 52.8 % had a symptomatic carotid stenosis. A decline in the rates of in-hospital major stroke (2.1, 1.9, 1.6, 0.9, p for trend 0.014) and of ipsilateral strokes (3.1, 2.4, 2.5, 1.6 %, p for trend 0.019) was substantiated with increasing site experience. This significant trend was preserved in the combined rate of major stroke and death (4.0, 3.2, 3.4, 2.4 %, p for trend 0.034).

Apart from CAS experience, improvements in CAS technique, a decreasing number of symptomatic patients and an increasing number of procedures under embolic protection (each p for trend <0.05) might have contributed to these results.

Conclusions

The results show a gradual reduction of in-hospital stroke rates with increasing center experience. Extensive supervision of CAS learners and further promotion of proctorship programs seem to be essential.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany

    Stephan Staubach, Ralph Hein-Rothweiler, Manuela Segerer & Harald Mudra

  2. Stiftung Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany

    Matthias Hochadel

  3. Herzzentrum Ludwigshafen, Ludwigshafen, Germany

    Ralf Zahn

  4. Medizinische Klinik I, Klinikum Worms, Worms, Germany

    Jens Jung

  5. Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum Bogenhausen, Munich, Germany

    Gotthard Rieß

  6. Kardiologie, Nephrologie, Pulmologie, Interventionelle Angiologie, Internistische Intensivmedizin, Leopoldina Krankenhaus, Schweinfurt, Germany

    Hubert Seggewiß

  7. Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Esslingen, Esslingen, Germany

    Andre Schneider

  8. Kardiologie und Angiologie, Klinikum Siloah, Hannover, Germany

    Thomas Fürste

  9. Klinik für Innere Medizin und Kardiologie, Marienhospital Osnabrück, Osnabrück, Germany

    Christian Gottkehaskamp

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  1. Stephan Staubach
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  2. Ralph Hein-Rothweiler
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  9. Andre Schneider
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Correspondence to Harald Mudra.

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Staubach, S., Hein-Rothweiler, R., Hochadel, M. et al. The role of endovascular expertise in carotid artery stenting: results from the ALKK-CAS-Registry in 5,535 patients. Clin Res Cardiol 101, 929–937 (2012). https://doi.org/10.1007/s00392-012-0479-4

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  • DOI: https://doi.org/10.1007/s00392-012-0479-4

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