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. 2013 Mar;8(1):50-56.
doi: 10.15420/icr.2013.8.1.50.

Carotid Artery Stenting - Strategies to Improve Procedural Performance and Reduce the Learning Curve

Willem Im Willaert  1 , Isabelle Van Herzeele  2   3
Affiliations

Carotid Artery Stenting - Strategies to Improve Procedural Performance and Reduce the Learning Curve

Willem Im Willaert et al. Interv Cardiol. 2013 Mar.

Abstract

Carotid artery stenting (CAS) remains an appealing intervention to reduce the stroke risk because of its minimal invasive nature. Nevertheless, landmark randomised controlled trials have not been able to resolve the controversies surrounding this complex procedure as the peri-operative stroke risk in a non-selected patient population still seems to be higher after CAS in comparison to carotid endarterectomy. What is more, these trials have highlighted that patient outcome after CAS is influenced by patient- and operator-dependant factors. The CAS procedure exhibits a definitive learning curve resulting in higher complication rates if the procedure is performed by inexperienced interventionists or in low-volume centres. This article will outline strategies to improve the performance of physicians carrying out the CAS procedure by means of proficiency-based training, credentialing, virtual reality rehearsal and optimal patient selection.

Keywords: Carotid artery stenting; learning curve; procedure rehearsal; training; virtual reality simulation.

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Conflict of interest statement

Disclosure: The authors received a research grant from Simbionix, Cleveland, US.

Figures

Figure 1:
Figure 1:. Evidence of In-trial Learning During CREST – Death or Major Stroke Rates in Carotid Artery Stenting Decrease for Symptomatic Patients with Time
Figure 2:
Figure 2:. Schematic Overview of the Steps of Patient-specific Rehearsal
Figure 3:
Figure 3:. Three Potential Rehearsal Environments – Laboratory, Simulated Operating Suite (Imperial College London) and the Angiosuite (So-called In Situ Simulation)
Figure 4:
Figure 4:. Anatomic Scoring System for Carotid Artery Stenting
See this image and copyright information in PMC

References

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