The learning curve associated with intracranial angioplasty and stenting: analysis from a single center.

BACKGROUND

Intracranial angioplasty and stenting is an optional treatment for patients with symptomatic intracranial artery stenosis (IAS) who have failed to respond to standard medical therapy. We aimed to analyze the effect of the operator's learning curve in our center in terms of the safety of intracranial angioplasty and stenting.

METHODS

In this retrospective study, we analyzed patients treated with intracranial angioplasty and stenting in our center between January 2007 and December 2015. The endpoint was peri-procedure complications within 30 days. A risk-adjusted cumulative sum chart was used for the learning curve analysis. Multivariable logistic analysis was also used to evaluate the effect of the learning curve on intracranial angioplasty and stenting.

RESULTS

A total of 329 patients were included. The overall peri-procedure complication rate was 8.21% (27/329). Multivariate logistic regression analysis showed that operators with experience of >20 cases [odds ratio (OR) =0.229; 95% confidence interval (CI): 0.059-0.893] and >40 cases (OR =0.024; 95% CI: 0.006-0.093) were associated with a low risk of complications compared with operators with experience of ≤20 cases. Furthermore, patients with hypertension (OR =3.595; 95% CI: 1.104-11.702) and stenosis of Mori classification C (OR =28.562; 95% CI: 4.788-170.395) were associated with a high risk of complications. The observed outcome was better than expected (more negative deflections) after the 30 consecutive case.

CONCLUSIONS

The level of operator experience can influence the risk of peri-procedure complications associated with intracranial angioplasty and stenting. A total of 30 consecutive cases is required for an operator to overcome the learning curve.