The role of endovascular expertise in carotid artery stenting: results from the ALKK-CAS-Registry in 5,535 patients
Clinical Research in Cardiology, 06/08/2012
Staubach S et al. – The results show a gradual reduction of in–hospital stroke rates with increasing center experience. Extensive supervision of carotid artery stenting (CAS) learners and further promotion of proctorship programs seem to be essential.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).
- 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.