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.

A novel catheter in patients with peripheral chronic total occlusions: a single center experience.

OBJECTIVES AND BACKGROUND: Recanalization of a chronic total occlusion (CTO) is technically challenging with less than optimum results in arterial disease. Crosser® is a novel technology that utilizes high frequency (20 KHz) vibration energy to fragment occlusive fibrous atherosclerotic plaque and helps in traversing the occluded vessel. We report a single center experience with this catheter as the primary device in peripheral chronic total occlusions. METHODS: The catheter was used as the primary device in 25 consecutive patients with peripheral CTOs. The peripheral CTOs in this study are defined as 100% occluded vessels involving any segment of the iliac artery or below the inguinal ligament down to the trifurcation vessels which have been occluded for greater than 3 months judged by patient's history of longstanding symptoms with no worsening in the past 3 months. Procedural success was defined by the ability of the device to facilitate guide wire crossing of the occlusion. All angiograms were evaluated by two operators. Data on demographics, angiographic variables, and patient complications was collected. RESULTS: The device was used in 25 consecutive patients and 27 CTO lesions were treated. Critical limb ischemia and claudication were the indications in 32 and 68% of the patients, respectively. Average lesion length was 117 mm (range 10-300 mm). Superficial femoral artery was the most common lesion site (n = 20, 74%). Crosser-assisted guide wire recanalization was achieved in 11(41%) lesions while the final overall procedure success rate with any device was 63% (n = 17). Perforation occurred in five lesions with one directly attributable to this device. CONCLUSIONS: In this single center observational review, the Crosser device in peripheral CTO lesions had a procedural success of 41%. © 2010 Wiley-Liss, Inc.