Impact of Symptoms, Gender, Co-Morbidities, and Operator Volume on Outcome of Carotid Artery Stenting (from the Nationwide Inpatient Sample [2006 to 2010])

Badheka, Apurva; Chothani, Ankit; Panaich, Sidakpal; Mehta, Kathan; Patel, Nileshkumar; Deshmukh, Abhishek; Singh, Vikas; Arora, Shilpkumar; Patel, Nilay; Grover, Peeyush; Shah, Neeraj; Savani, Chirag; Patel, Achint; Panchal, Vinaykumar; Brown, Michael D.; Kaki, Amir; Kondur, Ashok; Mohamad, Tamam; Elder, Mahir; Grines, Cindy L.; Schreiber, Theodore

doi:10.1016/j.amjcard.2014.06.030

Cited by 28 publications

(22 citation statements)

References 28 publications

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“…Other studies have also utilized regional and national databases to evaluate if annual CAS volume impacts outcome and, not surprisingly, have demonstrated decreased complications when CAS is performed by high-volume operators. 18–20 However, a study of 4,001 CAS procedures by Steppacher et al 7 did not demonstrate a difference in the in-patient death/ stroke rate based on operator volume, but their categories for physician volume were different from ours, and this may have affected the results. Their categories were separated into low (<9 cases/year), medium (9–23 cases/year), and high (>23 cases/ year), while our study considered operators with < 5 cases/year as low volume.…”

Section: Discussioncontrasting

confidence: 61%

Clinical Outcome of Carotid Artery Stenting According to Provider Specialty and Volume

AbuRahma

Campbell

Hariri

et al. 2017

Annals of Vascular Surgery

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Background Several studies have demonstrated better outcomes for carotid endarterectomy with high-volume hospitals and providers. However, only a few studies have reported on the impact of operator specialty/volume on the perioperative outcome of carotid artery stenting (CAS). This study will analyze the correlation of CAS outcomes and provider specialty and volume. Methods Prospectively collected data of CAS procedures done at our institution during a 10-year period were analyzed. Major adverse events (MAEs; 30-day stroke, myocardial infarction, and death) were compared according to provider specialty (vascular surgeons [VSs], interventional cardiologists [ICs], interventional radiologists [IRs], interventional vascular medicine [IVM]), and volume (≥5 CAS/year vs. <5 CAS/year). Results Four hundred fourteen CAS procedures (44% for symptomatic indications) were analyzed. Demographics/clinical characteristics were somewhat similar between specialties. MAE rates were not significantly different between various specialties: 3.1% for IC, 6.3% for VS, 7.1% for IR, 6.7% for IVM (P = 0.3121; 6.3% for VS and 3.8% for others combined, P = 0.2469). When physicians with <5 CAS/year were excluded: the MAE rates were 3.1% for IC, 4.7% for VS, and 6.7% for IVM (P = 0.5633). When VS alone were compared with others, and physicians with <5 CAS/year were excluded, the MAE rates were 4.7% for VS vs. 3.6% for non-VS (P = 0.5958). The MAE rates for low-volume providers, regardless of their specialty, were 9.5% vs. 4% for high-volume providers (P = 0.1002). Logistic regression analysis showed that the odds ratio of MAE was 0.4 (0.15–1.1, P = 0.0674) for high-volume providers, while the odds ratio for VS was 1.3 (0.45–3.954, P = 0.5969). Conclusions Perioperative MAE rates for CAS were similar between various providers, regardless of specialties, particularly for vascular surgeons with similar volume to nonvascular surgeons. Low-volume providers had higher MAE rates.

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Section: Discussioncontrasting

confidence: 61%

Clinical Outcome of Carotid Artery Stenting According to Provider Specialty and Volume

AbuRahma

Campbell

Hariri

et al. 2017

Annals of Vascular Surgery

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“…18,19 Women have been shown previously to have poorer outcomes compared with men after CAS. 20 is also associated with an increased likelihood of a calcified plaque. 21 Assessing the impact of these complications is difficult as the disability after MI or CVA cannot be determined using large national databases.…”

Section: Discussionmentioning

confidence: 99%

Predictors of poor outcome after carotid intervention

Dua

Romanelli

Upchurch

et al. 2016

Journal of Vascular Surgery

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Higher rates of postoperative stroke and inpatient mortality for women undergoing CAS is an unexpected finding, and may indicate that this population is vulnerable to complications after endovascular management. Low volume is a predictor of complications and subsequent mortality primarily for CAS. Patients who undergo CEA continue to have superior outcomes compared with matched cohorts who undergo CAS.

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“…These hospitals might still be early in their learning curves, and therefore the infrastructure, protocol, staff training, and follow‐up program might be suboptimal. Hospital volume has been shown to influence the procedure outcomes of endovascular procedures including elective and primary coronary intervention, endovascular repair of abdominal aortic aneurysms, and peripheral artery disease . With different nature and incidence of diseases, and the complexity of devices and techniques, the minimal annual procedures required to keep optimal procedural outcome vary widely in different interventions.…”

Section: Discussionmentioning

confidence: 99%

Impact of hospital volume on long‐term neurological outcome in patients undergoing carotid artery stenting

Hung

Yeh

Lin

et al. 2017

Cathet Cardio Intervent

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Impact of Symptoms, Gender, Co-Morbidities, and Operator Volume on Outcome of Carotid Artery Stenting (from the Nationwide Inpatient Sample [2006 to 2010])

Cited by 28 publications

References 28 publications

Clinical Outcome of Carotid Artery Stenting According to Provider Specialty and Volume

Clinical Outcome of Carotid Artery Stenting According to Provider Specialty and Volume

Predictors of poor outcome after carotid intervention

Impact of hospital volume on long‐term neurological outcome in patients undergoing carotid artery stenting

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