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Effect of Operator's Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study.
Zhu, François; Ben Hassen, Wagih; Bricout, Nicolas; Kerleroux, Basile; Janot, Kevin; Gory, Benjamin; Anxionnat, René; Richard, Sébastien; Marchal, Adrien; Blanc, Raphael; Piotin, Michel; Consoli, Arturo; Trystram, Denis; Rodriguez Regent, Christine; Desilles, Jean-Philippe; Weisenburger-Lile, David; Escalard, Simon; Herbreteau, Denis; Ifergan, Heloise; Lima Maldonado, Igor; Labreuche, Julien; Henon, Hilde; Naggara, Olivier; Lapergue, Bertrand; Boulouis, Grégoire.
Afiliación
  • Zhu F; Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.).
  • Ben Hassen W; GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).
  • Bricout N; Department of Neuroradiology, CHRU Lille, France (N.B., A.M.).
  • Kerleroux B; GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).
  • Janot K; Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.).
  • Gory B; Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.).
  • Anxionnat R; Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.).
  • Richard S; Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.).
  • Marchal A; Department of Neurology, Stroke Unit, CHRU Nancy and INSERM U1116, F-54000, Université de Lorraine, Nancy, France (S.R.).
  • Blanc R; Department of Neuroradiology, CHRU Lille, France (N.B., A.M.).
  • Piotin M; Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.).
  • Consoli A; Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.).
  • Trystram D; Department of Neuroradiology, Foch Hospital, Suresnes, France (A.C.).
  • Rodriguez Regent C; GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).
  • Desilles JP; GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).
  • Weisenburger-Lile D; Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.).
  • Escalard S; Department of Neurology, Stroke Unit, Foch Hospital, Suresnes, France (D.W.-L., B.L.).
  • Herbreteau D; Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.).
  • Ifergan H; Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.).
  • Lima Maldonado I; Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.).
  • Labreuche J; UMR 1253 iBrain, Inserm, Université de Tours, Tours, France (I.L.M.).
  • Henon H; CHRU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, Lille, France (J.L.).
  • Naggara O; Department of Neurology, Stroke Unit, CHRU Lille, Lille, France (H.H.).
  • Lapergue B; GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).
  • Boulouis G; Department of Neurology, Stroke Unit, Foch Hospital, Suresnes, France (D.W.-L., B.L.).
Stroke ; 52(9): 2736-2742, 2021 08.
Article en En | MEDLINE | ID: mdl-34233462
BACKGROUND AND PURPOSE: We aimed to evaluate among trained interventional neuroradiologist, whether increasing individual experience was associated with an improvement in mechanical thrombectomy (MT) procedural performance metrics. METHODS: Individual MT procedural data from 5 centers of the Endovascular Treatment in Ischemic Stroke registry and 2 additional high-volume stroke centers were pooled. Operator experience was defined for each operator as a continuous variable, cumulating the number of MT procedures performed since January 2015, as MT became standard of care or, if later than this date, since the operator started performing mechanical thrombectomies in autonomy. We tested the associations between operator's experience and procedural metrics. RESULTS: A total of 4516 procedures were included, performed by 36 operators at 7 distinct centers, with a median of 97.5 endovascular treatment procedures per operator (interquartile range, 57-170.2) over the study period. Higher operator's experience, analyzed as a continuous variable, was associated with a significantly shorter procedural duration (ß estimate, -3.98 [95% CI, -5.1 to -2.8]; P<0.001), along with local anesthesia and M1 occlusion location in multivariable models. Increasing experience was associated with better Thrombolysis in Cerebral Infarction scores (estimate, 1.02 [1-1.04]; P=0.013). CONCLUSIONS: In trained interventional neuroradiologists, increasing experience in MT is associated with significantly shorter procedural duration and better reperfusion rates, with a theoretical ceiling effect observed after around 100 procedures. These results may inform future training and practice guidelines to set minimal experience standards before autonomization, and to set-up operators' recertification processes tailored to individual case volume and prior experience.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Isquemia Encefálica / Trombectomía / Accidente Cerebrovascular / Cirujanos Tipo de estudio: Clinical_trials / Guideline / Prognostic_studies Límite: Humans Idioma: En Revista: Stroke Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Isquemia Encefálica / Trombectomía / Accidente Cerebrovascular / Cirujanos Tipo de estudio: Clinical_trials / Guideline / Prognostic_studies Límite: Humans Idioma: En Revista: Stroke Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos