title: Carotid artery stenting: high-risk interventionist versus high-risk center.
abstract: Carotid artery stenting (CAS) is a less invasive alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. Although early multicenter randomized controlled trials reported inferior results for CAS compared with CEA, recent advances in technology and increasing CAS operator expertise have lead to improved results. As with any procedure, a high caseload translates into increased experience and better outcomes. This article discusses the current shortfalls of CAS, as well as the various options available to improve CAS results. The majority of studies suggest that there is an inverse relationship between caseload volume and CAS outcomes that defines high-risk interventionists and high-risk centers. Centralizing CAS procedures to high-volume centers is essential for optimization of CAS outcomes.
authors.affiliation: St. George's Vascular Institute, St. George's Healthcare NHS Trust, London, UK - Ian.Loftus@stgeorges.nhs.uk.
authors.forename: K I
authors.initials: KI
authors.lastname: Paraskevas
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality / Q000592:standards; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002983:Clinical Competence / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome