Clinical Research in Cardiology

, Volume 101, Issue 11, pp 929–937 | Cite as

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

  • Stephan Staubach
  • Ralph Hein-Rothweiler
  • Matthias Hochadel
  • Manuela Segerer
  • Ralf Zahn
  • Jens Jung
  • Gotthard Rieß
  • Hubert Seggewiß
  • Andre Schneider
  • Thomas Fürste
  • Christian Gottkehaskamp
  • Harald Mudra
Original Paper



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).


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).


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.


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.


Carotid artery stenosis Cartotid artery stenting Death or stroke Learning curve Center experience 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Stephan Staubach
    • 1
  • Ralph Hein-Rothweiler
    • 1
  • Matthias Hochadel
    • 2
  • Manuela Segerer
    • 1
  • Ralf Zahn
    • 3
  • Jens Jung
    • 4
  • Gotthard Rieß
    • 5
  • Hubert Seggewiß
    • 6
  • Andre Schneider
    • 7
  • Thomas Fürste
    • 8
  • Christian Gottkehaskamp
    • 9
  • Harald Mudra
    • 1
  1. 1.Klinik für Kardiologie, Pneumologie und Internistische IntensivmedizinKlinikum NeuperlachMunichGermany
  2. 2.Stiftung Institut für Herzinfarktforschung an der Universität HeidelbergLudwigshafenGermany
  3. 3.Herzzentrum LudwigshafenLudwigshafenGermany
  4. 4.Medizinische Klinik I, Klinikum WormsWormsGermany
  5. 5.Klinik für Kardiologie und Internistische IntensivmedizinKlinikum BogenhausenMunichGermany
  6. 6.Kardiologie, Nephrologie, Pulmologie, Interventionelle Angiologie, Internistische IntensivmedizinLeopoldina KrankenhausSchweinfurtGermany
  7. 7.Klinik für Kardiologie, Angiologie, PneumologieKlinikum EsslingenEsslingenGermany
  8. 8.Kardiologie und AngiologieKlinikum SiloahHannoverGermany
  9. 9.Klinik für Innere Medizin und KardiologieMarienhospital OsnabrückOsnabrückGermany

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