Carotid artery stenting: effect of learning curve and intermediate-term morphological outcome.
OBJECTIVE
To assess the impact of learning on the rate of success and complications of carotid stenting in a single-center, one-operator series and prospectively follow a patient cohort with regard to restenosis.


METHODS
In 303 patients (mean age 70 +/- 8.8 years), 320 internal carotid arteries (ICA) were treated with carotid stenting for stenoses > or = 70%. Four groups of 80 consecutive interventions were compared with regard to primary technical success and periprocedural complications. Stent patency in follow-up was assessed using duplex scanning.


RESULTS
Stenting was successful in 298 (93%) arteries. The combined neurological complications (transient ischemic attacks and all strokes) and 30-day death rate was 8.2% (n = 25), but the all stroke and 30-day death rate was 3.0% (n = 9). A significant reduction in the frequency of neurological complications after the initial 80 interventions was observed (p = 0.03), but technical success was not appreciably improved with increasing experience thereafter. Over a median 12 months (interquartile range 6 to 24), cumulative patency rates were 91%, 90%, and 91% at 6, 12, and 36 months, respectively.


CONCLUSIONS
Elective carotid stenting can be performed with excellent technical success, an acceptable frequency of periprocedural complications, and good intermediate-term patency. However, our findings suggest that a larger number of interventions should be performed to overcome the negative effects of the initial learning phase.
Ahmadi
R
R
Department of Angiology, General Hospital Vienna, University of Vienna Medical School, Austria. erich.minar@akh-wien.ac.at
Willfort
A
A
Lang
W
W
Schillinger
M
M
Alt
E
E
Gschwandtner
M E
ME
Haumer
M
M
Maca
T
T
Ehringer
H
H
Minar
E
E
D000368:Aged; D016893:Carotid Stenosis / Q000628:therapy*; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency