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Learning Curve for Surgeons Adopting Transcarotid Artery Revascularization Based on the Vascular Quality Initiative-Transcarotid Artery Revascularization Surveillance Project.

Abstract：

BACKGROUND:Transcarotid artery revascularization (TCAR) with flow reversal was recently introduced as a novel technique for carotid artery stenting (CAS). We examined the learning curve of surgeons adopting TCAR based on data from the Vascular Quality Initiative (VQI-TCAR Surveillance Project; TSP). STUDY DESIGN:We identified all patients in the TSP who underwent TCAR from September 2016 to December 2018. Cases were numbered in chronological order for each unique surgeon. Patients were then divided into 4 levels based on surgeon case number for comparison: cases 1 to 5 (novice), cases 6 to 20 (intermediate), cases 20 to 30 (advanced), and cases >30 (expert). RESULTS:During the study period, 3,456 TCAR procedures were performed by 417 unique surgeons from 178 centers. Of all procedures, 1,426 (41%) were performed at the novice level, 1,375 (40%) at the intermediate level, 307 (8.9%) at the advanced level, and 348 (10%) at the expert level. Cases performed at more advanced levels had lower operative times (novice 82 vs intermediate 73 vs advanced 62 vs expert 60 minutes, p < 0.001), fluoroscopy time (7 vs 6 vs 5 vs 5 minutes, p < 0.001), and flow reversal time (12 vs 11 vs 10 vs 10 minutes, p < 0.001). Cases done at more advanced levels had decreases in bleeding (3.9% vs 3.4% vs 1.6% vs 1.2%, p = 0.03). No differences in major in-hospital outcomes were found regardless of experience level including stroke (p = 0.99), death (p = 0.39), and composite stroke/death/myocardial infarction (p = 0.84). CONCLUSIONS:Transcarotid artery revascularization is being performed with excellent stroke and mortality rates in the TSP, even in the early stages of the surgeons' learning curve. Bleeding complications, operative, fluoroscopy, and flow reversal times all decrease with increasing TCAR experience.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Kashyap VS,King AH,Liang P,Eldrup-Jorgensen J,Wang GJ,Malas MB,Nolan BW,Cronenwett JL,Schermerhorn ML

doi

10.1016/j.jamcollsurg.2019.09.020

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

113-120

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(19)32140-4

journal_volume

230

pub_type

杂志文章

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Learning Curve for Surgeons Adopting Transcarotid Artery Revascularization Based on the Vascular Quality Initiative-Transcarotid Artery Revascularization Surveillance Project.