Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China.
Catheter Cardiovasc Interv. 2014 Jan 1;83(1):E94-100. doi: 10.1002/ccd.25038. Epub 2013 Jul 1.
To identify the specific caseload to overcome learning curve effect based on data from consecutive patients treated with Intracranial Angioplasty and Stenting (IAS) in our center.
The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis trial was prematurely terminated owing to the high rate of periprocedural complications in the endovascular arm. To date, there are no data available for determining the essential caseload sufficient to overcome the learning effect and perform IAS with an acceptable level of complications.
Between March 2004 and May 2012, 188 consecutive patients with 194 lesions who underwent IAS were analyzed retrospectively. The outcome variables used to assess the learning curve were periprocedural complications (included transient ischemic attack, ischemic stroke, vessel rupture, cerebral hyperperfusion syndrome, and vessel perforation). Multivariable logistic regression analysis was employed to illustrate the existence of learning curve effect on IAS. A risk-adjusted cumulative sum chart was performed to identify the specific caseload to overcome learning curve effect.
The overall rate of 30-days periprocedural complications was 12.4% (24/194). After adjusting for case-mix, multivariate logistic regression analysis showed that operator experience was an independent predictor for periprocedural complications. The learning curve of IAS to overcome complications in a risk-adjusted manner was 21 cases.
Operator's level of experience significantly affected the outcome of IAS. Moreover, we observed that the amount of experience sufficient for performing IAS in our center was 21 cases.
根据我们中心连续接受颅内血管成形术和支架置入术（IAS）治疗的患者数据，确定克服学习曲线效应的具体病例量。
由于血管内治疗组围手术期并发症发生率高，支架置入和强化药物治疗预防复发性卒中和颅内狭窄试验提前终止。迄今为止，尚无数据可确定足以克服学习效应并以可接受的并发症水平进行 IAS 的必要病例量。
回顾性分析 2004 年 3 月至 2012 年 5 月期间连续 188 例 194 处病变接受 IAS 的患者。用于评估学习曲线的结局变量包括围手术期并发症（包括短暂性脑缺血发作、缺血性卒、血管破裂、脑过度灌注综合征和血管穿孔）。采用多变量逻辑回归分析说明 IAS 上存在学习曲线效应。进行风险调整累积和图以确定克服学习曲线效应的具体病例量。
30 天围手术期并发症的总发生率为 12.4%（24/194）。在调整病例组合后，多变量逻辑回归分析显示，术者经验是围手术期并发症的独立预测因素。以风险调整的方式克服并发症的 IAS 学习曲线为 21 例。
术者的经验水平显著影响 IAS 的结果。此外，我们观察到在我们中心进行 IAS 所需的经验量为 21 例。
