Portal de Periódicos da CAPES

Carotid Stenting

2013; Lippincott Williams & Wilkins; Volume: 45; Issue: 2 Linguagem: Inglês

10.1161/strokeaha.113.003526

1524-4628

David Calvet, Jean‐Louis Mas, Ale Algra, Jean‐Pierre Becquemin, Leo H. Bonati, Joanna Dobson, Gustav Fraedrich, Olav Jansen, Willem P.Th.M. Mali, Peter A. Ringleb, Gilles Chatellier, Martin M. Brown, David Calvet, Jean‐Louis Mas, Ale Algra, J.-P. Becquemin, Leo H. Bonati, Joanna Dobson, Gustav Fraedrich, Olav Jansen, Willem P.Th.M. Mali, Peter A. Ringleb, Gilles Châtellier, Martin M. Brown, Ale Algra, J.-P. Becquemin, Gilles Chatellier, Jean‐Louis Mas, Gustav Fraedrich, Peter A. Ringleb, Olav Jansen, Leo H. Bonati, Martin M. Brown, Willem P.Th.M. Mali, Jean‐Louis Mas, Gilles Chatellier, J.-P. Becquemin, Jean‐François Bonneville, Alain Branchereau, D. Crochet, J. C. Gaux, V. Larrue, Didier Leys, J Watelet, W. Hacke, Michael G. Hennerici, Jens‐Rainer Allenberg, P.C. Maurer, Hans‐Henning Eckstein, H. Zeumer, Olav Jansen, Ale Algra, John Bamford, Jonathan Beard, Martin Bland, A W Bradbury, Martin M. Brown, A. Clifton, P.A. Gaines, W. Hacke, Alison Halliday, Iqbal Malik, Jean‐Louis Mas, Alistair McGuire, Paul S. Sidhu, G.S. Venables,

Cardiovascular Health and Disease Prevention

Randomized clinical trials show higher 30-day risk of stroke or death after carotid artery stenting compared with surgery. We examined whether operator experience is associated with 30-day risk of stroke or death in the Carotid Stenting Trialists' Collaboration database.The Carotid Stenting Trialists' Collaboration is a pooled individual patient database including all patients recruited in 3 randomized trials of stenting versus endarterectomy for symptomatic carotid stenosis (Endarterectomy Versus Angioplasty in patients with Symptomatic Severe Carotid Stenosis trial, Stent-Protected Angioplasty versus Carotid Endarterectomy trial, and International Carotid Stenting Study). Lifetime carotid artery stenting experience, lifetime experience in stenting procedures excluding the carotid, and annual number of procedures performed within the trial (in-trial volume), divided into tertiles, were used to measure operator experience. The outcome event was the occurrence of any stroke or death within 30 days of the procedure. The analysis was done per protocol.Among 1546 patients who underwent carotid artery stenting, 120 (7.8%) had a stroke or death within 30 days of the procedure. The 30-day risk of stroke or death did not differ according to operator lifetime carotid artery stenting experience (P=0.8) or operator lifetime stenting experience excluding the carotid (P=0.7). In contrast, the 30-day risk of stroke or death was significantly higher in patients treated by operators with low (mean ≤3.2 procedures/y; risk 10.1%; adjusted risk ratio=2.30 [1.36-3.87]) and intermediate annual in-trial volumes (3.2-5.6 procedures/y; 8.4%; adjusted risk ratio=1.93 [1.14-3.27]) compared with patients treated by high annual in-trial volume operators (>5.6 procedures/y; 5.1%).Carotid stenting should only be performed by operators with annual procedure volume ≥6 cases per year.