Author + information
- Received January 9, 2014
- Revision received May 8, 2014
- Accepted May 23, 2014
- Published online November 1, 2014.
- Mehdi H. Shishehbor, DO, MPH, PhD∗∗ (, )
- Sridhar Venkatachalam, MD∗,
- William A. Gray, MD†,
- Christopher Metzger, MD‡,
- Brajesh K. Lal, MD§,
- Lei Peng, MSc‖,
- Hend L. Omran, BA‖ and
- Eugene H. Blackstone, MD∗
- ∗Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- †Department of Medicine, Center for Interventional Vascular Therapy, Columbia University, New York, New York
- ‡Wellmont CVA Heart Institute, Kingsport, Tennessee
- §Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
- ‖Endovascular Clinical Science Division, Abbott Laboratories, Santa Clara, California
- ↵∗Reprint requests and correspondence:
Dr. Mehdi H. Shishehbor, Department of Cardiovascular Medicine, Desk J3-05, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195.
Objectives This study sought to examine operator experience measured by time-related variables on outcomes with protected carotid artery stenting (CAS).
Background Studies on experience have focused on operator and institutional CAS volumes alone in the absence of a better metric.
Methods Using the CHOICE (Carotid Stenting for High Surgical-Risk Patients; Evaluating Outcomes Through the Collection of Clinical Evidence) multicenter prospective data from October 1, 2006 to June 1, 2012, 5,841 evaluable subjects were identified. Operator experience within this study was assessed using 5 variables for each operator: 1) baseline CAS volume; 2) time from first CAS to each subsequent CAS; 3) time between each CAS; 4) CAS volume in the institution; and 5) medical specialty (cardiology, surgery, or radiology/neurology). Institutional experience was determined by CAS volume within the study. Embolic protection device dwell time was used to assess technical performance, and 30-day death, stroke, or myocardial infarction composed the clinical outcome. Hierarchical logistic regression and linear mixed models were used.
Results Cardiologists (p < 0.001) along with operators with longer time interval from first CAS (p < 0.001) had reduced embolic protection device dwell times (technical performance). Increased time interval between CAS was the only independent predictor of 30-day death, stroke, or myocardial infarction (adjusted odds ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.005). Prolonged embolic protection device dwell time was associated with 30-day death, stroke, or myocardial infarction (adjusted odds ratio: 1.08; 95% confidence interval: 1.01 to 1.17; p = 0.03).
Conclusions The time interval between CAS procedures, specialty assignment, and time from first CAS are important measures of operator experience that may significantly affect technical performance and clinical outcome.
The CHOICE trial was sponsored and funded by Abbott Vascular. Dr. Shishehbor is a consultant and educator for Abbott Vascular, Medtronic, Covidien, Spectranetics, and Bayer but has waived all personal compensation. Dr. Gray has served on the Advisory Board of Abbott Vascular; has received research support from Abbott Vascular; and has served on the Steering Committee of the CHOICE trial. Dr. Metzger has served as a consultant for Abbott Vascular, Cordis, and Medtronic; and has an agreement for performing “hands-on” carotid courses for Abbott Vascular, but he has received no stocks, interests, grants, or research support. Ms. Peng is a full-time, stock-holding employee of Abbott Vascular. Ms. Omran is a full-time employee of Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 9, 2014.
- Revision received May 8, 2014.
- Accepted May 23, 2014.
- American College of Cardiology Foundation