Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany -
Department of Cardiology, Faculty of Medicine, University Clinic of Cardiology, University of St. Cyril & Methodius, Skopje, Republic of North Macedonia.
J Cardiovasc Surg (Torino). 2024 Jun;65(3):195-204. doi: 10.23736/S0021-9509.24.13069-8.
In contemporary clinical practice, carotid artery stenting (CAS) is increasingly becoming a multispecialty field, joining operators of various training backgrounds, which bring forth their unique expertise, patient management philosophies, and procedural preferences. The best practices and approaches, however, are still debated. Therefore, real-world insights on different operator preferences and related outcomes are of utmost value, yet still rather scarce in the available literature.
Using the data collected in the ROADSAVER observational, European multicenter CAS study, a prespecified comparative analysis evaluating the impact of the operator's specialization was performed. We used major adverse event (MAE) rate at 30-day follow-up, defined as the cumulative incidence of any death or stroke, and its components as outcome measures.
A total of 1965 procedures were analyzed; almost half 878 (44.7%) were performed by radiologists (interventional/neuro), 717 (36.5%) by cardiologists or angiologists, and 370 (18.8%) by surgeons (vascular/neuro). Patients treated by surgeons were the oldest (72.9±8.5), while radiologists treated most symptomatic patients (58.1%) and more often used radial access (37.2%). The 30-day MAE incidence achieved by cardiologists/angiologists was 2.0%, radiologists 2.5%, and surgeons 1.9%; the observed differences in rates were statistically not-significant (P=0.7027), even when adjusted for baseline patient/lesion and procedural disparities across groups. The corresponding incidence rates for death from any cause were 1.0%, 0.8%, and 0.3%, P=0.4880, and for any stroke: 1.4%, 2.3%, and 1.9%, P=0.4477, respectively.
Despite the disparities in patient selection and procedural preferences, the outcomes achieved by different specialties in real-world, contemporary CAS practice remain similar when using modern devices and techniques.
在当代临床实践中，颈动脉支架置入术（CAS）越来越成为一个多学科领域，汇集了各种培训背景的操作者，他们带来了自己独特的专业知识、患者管理理念和手术偏好。然而，最佳实践和方法仍存在争议。因此，不同操作者偏好及其相关结果的真实世界见解具有极高的价值，但在现有文献中仍然相当稀缺。
使用 ROADSAVER 观察性、欧洲多中心 CAS 研究中收集的数据，进行了一项预设的对比分析，评估了操作者专业化的影响。我们使用 30 天随访时的主要不良事件（MAE）发生率作为结局指标，定义为任何死亡或卒中的累积发生率及其组成部分。
共分析了 1965 例手术；近一半 878 例（44.7%）由放射科医生（介入/神经科）进行，717 例（36.5%）由心脏病专家或血管造影师进行，370 例（18.8%）由外科医生（血管/神经科）进行。外科医生治疗的患者年龄最大（72.9±8.5），而放射科医生治疗的大多数是有症状的患者（58.1%），并且更常使用桡动脉入路（37.2%）。心脏病专家/血管造影师的 30 天 MAE 发生率为 2.0%，放射科医生为 2.5%，外科医生为 1.9%；尽管调整了各组之间的基线患者/病变和手术差异，各组之间的差异无统计学意义（P=0.7027）。相应的任何原因死亡发生率为 1.0%、0.8%和 0.3%，P=0.4880，任何卒中发生率为 1.4%、2.3%和 1.9%，P=0.4477。
尽管在患者选择和手术偏好方面存在差异，但在使用现代器械和技术的真实世界当代 CAS 实践中，不同专业的治疗结果仍然相似。
