Operator Experience and Carotid Stenting Outcomes in Medicare Beneficiaries

Abstract

Carotid stenting is increasingly being used to treat severe carotid atherosclerosis, an important cause of ischemic stroke.¹ Since approval of the first carotid stent system by the US Food and Drug Administration (FDA) in 2004, use of carotid stenting has more than doubled in Medicare beneficiaries.² Explanations for the rapid dissemination of carotid stenting into routine clinical practice include its minimally invasive nature, lack of need for general anesthesia, and an expanded pool of physicians capable of performing it.³ Yet despite its overall promise, the increasing use of carotid stenting also raises potential concern. Carotid stenting is a technically demanding procedure and earlier studies have demonstrated a substantial learning curve with it.^4,5 Although this has prompted consideration of establishing minimum volume requirements and training criteria for potential operators,^6-8 specific recommendations have varied across professional organizations, and none have been widely enforced.⁹ As such, the total number of operators currently performing carotid stenting in routine clinical practice and their overall experiences and outcomes with the procedure remain largely unknown.