Can experienced physicians with high peripheral interventional volume but low carotid artery stenting (CAS) volume achieve low complication rates during CAS?

AIMS: It has been stated that experienced physicians with a high volume of carotid artery stent (CAS) procedures have low complication rates, including cerebrovascular accidents (CVA). Complication rates, however, are not known for physicians with a low volume of CAS (<50 CAS/yr) but with a high volume of other peripheral endovascular procedures. Since the techniques used in CAS are similar to those used routinely in other peripheral interventions, we hypothesise that high volume peripheral interventional operators with appropriate training would have low complication rates during CAS procedures.

METHODS AND RESULTS: We reviewed all CAS procedures that were performed from 2004-2009 by an experienced physician with a high peripheral interventional volume (>250 interventions/year). Filter-based embolic protection devices were used during each CAS procedure. Each patient was followed for 30 days and data on major adverse cardiac and cerebral events (MACCE) collected. Ninety-two patients with ninety-five lesions were treated with CAS. Recent CVA was the indication in half of the patients and asymptomatic high-grade stenosis was the indication in the other half. Twenty-one (23%) patients had previous history of CEA and six (7%) patients had previous CAS in the contralateral side. All CAS procedures were technically successful. One patient (1.1%) had a TIA with total resolution of symptoms in ten minutes. There were no major strokes. MACCE rate was 1.1% at 30 days.

CONCLUSIONS: We found a very low complication rate following CAS with embolic protection performed by an experienced physician who has a relatively low CAS volume but a high volume of other peripheral interventions.