Cai Qiankun, Zhu Yuyou, Huang Xianjun, Xiao Lulu, Gu Mengmeng, Wang Peng, Zhang Chao, Chen Jixing, Hu Wei, Wang Guoping, Sun Wen
Department of Neurology, Second Affiliated Hospital, Fujian Medical University, Quanzhou, China.
Department of Neurology, Stroke Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
Front Neurol. 2021 Jan 14;11:587409. doi: 10.3389/fneur.2020.587409. eCollection 2020.
Data concerning the learning curve for endovascular treatment (EVT) of anterior circulation large vessel occlusion are scarce. This study aimed to investigate the relationship between operator experience and the outcome of EVT and to further identify the number of cases needed to acquire the ability to perform successful reperfusion. Four hundred and thirty-four patients who underwent EVT by seven operators at a single center from January 2016 to September 2019 were enrolled. Procedural experience was defined by the number of cases performed by each operator. Multivariable backward regression analyses were used to investigate the association between procedural experience and functional independence (defined as a modified Rankin Scale score of 0-2), 90-days mortality, successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3), and puncture-to-reperfusion time after adjusting for covariates. A risk-adjusted cumulative sum (RA-CUSUM) chart was utilized to identify the number of caseloads needed to overcome the learning curve effect. Procedural experience was independently associated with functional independence, 90-days mortality, successful reperfusion, and puncture-to-reperfusion time reduction (per 10-case increment: OR 1.219, 95% CI: 1.079-1.383, < 0.001; OR 0.847, 95% CI: 0.738-0.968, = 0.016; OR 1.553, 95% CI: 1.332-1.830, < 0.001 and β 8.087 min, 95% CI: 6.184-9.991, < 0.001, respectively). The RA-CUSUM chart indicated that at least 29 cases were required to overcome the learning curve effect. There was a dose-response relationship between operator case volume and clinical outcome, procedure time, and successful reperfusion. The experience needed for successful EVT was at least 29 cases.
关于前循环大血管闭塞血管内治疗（EVT）学习曲线的数据很少。本研究旨在调查术者经验与EVT结果之间的关系，并进一步确定获得成功再灌注能力所需的病例数。纳入了2016年1月至2019年9月在单一中心由7位术者进行EVT的434例患者。手术经验由每位术者所施行的病例数定义。采用多变量向后回归分析来研究手术经验与功能独立性（定义为改良Rankin量表评分为0 - 2）、90天死亡率、成功再灌注（定义为改良脑梗死溶栓评分2b - 3）以及在调整协变量后穿刺至再灌注时间之间的关联。使用风险调整累积和（RA - CUSUM）图来确定克服学习曲线效应所需的病例数。手术经验与功能独立性、90天死亡率、成功再灌注以及穿刺至再灌注时间缩短独立相关（每增加10例：OR 1.219，95%CI：1.079 - 1.383，P < 0.001；OR 0.847，95%CI：0.738 - 0.968，P = 0.016；OR 1.553，95%CI：1.332 - 1.830，P < 0.001以及β 8.087分钟，95%CI：6.184 - 9.991，P < 0.001）。RA - CUSUM图表明至少需要29例才能克服学习曲线效应。术者病例量与临床结局、手术时间和成功再灌注之间存在剂量反应关系。成功进行EVT所需的经验至少为29例。
