Clinical Research in Cardiology

, Volume 101, Issue 11, pp 929–937

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

Authors

  • Stephan Staubach
    • Klinik für Kardiologie, Pneumologie und Internistische IntensivmedizinKlinikum Neuperlach
  • Ralph Hein-Rothweiler
    • Klinik für Kardiologie, Pneumologie und Internistische IntensivmedizinKlinikum Neuperlach
  • Matthias Hochadel
    • Stiftung Institut für Herzinfarktforschung an der Universität Heidelberg
  • Manuela Segerer
    • Klinik für Kardiologie, Pneumologie und Internistische IntensivmedizinKlinikum Neuperlach
  • Ralf Zahn
    • Herzzentrum Ludwigshafen
  • Jens Jung
    • Medizinische Klinik I, Klinikum Worms
  • Gotthard Rieß
    • Klinik für Kardiologie und Internistische IntensivmedizinKlinikum Bogenhausen
  • Hubert Seggewiß
    • Kardiologie, Nephrologie, Pulmologie, Interventionelle Angiologie, Internistische IntensivmedizinLeopoldina Krankenhaus
  • Andre Schneider
    • Klinik für Kardiologie, Angiologie, PneumologieKlinikum Esslingen
  • Thomas Fürste
    • Kardiologie und AngiologieKlinikum Siloah
  • Christian Gottkehaskamp
    • Klinik für Innere Medizin und KardiologieMarienhospital Osnabrück
    • Klinik für Kardiologie, Pneumologie und Internistische IntensivmedizinKlinikum Neuperlach
Original Paper

DOI: 10.1007/s00392-012-0479-4

Cite this article as:
Staubach, S., Hein-Rothweiler, R., Hochadel, M. et al. Clin Res Cardiol (2012) 101: 929. doi:10.1007/s00392-012-0479-4

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.

Keywords

Carotid artery stenosisCartotid artery stentingDeath or strokeLearning curveCenter experience

Copyright information

© Springer-Verlag 2012