title: Carotid artery stenting, what can be learned after more than 1,000 patients: a single centre single operator experience.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the outcome of carotid artery stenting (CAS) in a single, high-volume centre of a single operator and to analyse the circumstances under which complications occur. Recent trials comparing CAS with carotid endarterectomy demonstrated controversial results. The low experience of interventionists in performing CAS was a major limitation of these studies. The number of procedures needed to achieve optimal skills is unknown.
  
  
  RESULTS
  From May 1997 until April 2010, 1,004 patients with symptomatic or asymptomatic carotid artery stenosis underwent CAS by a single operator. A cerebral protection device was in mandatory use since 2000. In-hospital complication rates were defined as the cumulative rate of death, myocardial infarction or stroke. Procedural success was achieved in 97.77% of patients. The perioperative complication rate was 1.69% including 0.2% deaths, 1.1% patients with minor stroke, 0.4% patients with major stroke. In 88% (15 out of 17) of the patients with complications, unfavourable anatomical or procedural factors could be identified. After the first 100 CAS performed,the complication rate was at 3% and significantly decreased to 1% after more than 500 procedures. Patients ≥80 years had a significantly higher complication rate.
  
  
  CONCLUSIONS
  In a high-volume experienced centre, the in-hospital complication rate is low. Complications occurred almost exclusively in patients with unfavourable anatomical or procedural characteristics and seem to be avoidable in most patients. A learning curve was observed up to 500 procedures. Elderly patients have a higher complication rate.
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Germany.
authors.forename: Klaudija
authors.initials: K
authors.lastname: Bijuklic
authors.forename: Thilo
authors.initials: T
authors.lastname: Tübler
authors.forename: Andreas
authors.initials: A
authors.lastname: Wandler
authors.forename: Heinrich
authors.initials: H
authors.lastname: Goossens-Merkt
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome