The learning curve for neuroendovascular procedures

Abstract

In recent years, both patients and third-party payers have become more interested in the impact of physician and hospital experience and the outcomes of technically demanding procedures. Initiatives such as the Leapfrog Group have been organized and there has been a suggestion that complex procedures should be referred to more experienced centers.1 In this issue of Neurology ®, results are presented from the NIH Wingspan Registry for patients who underwent intracranial stenting for symptomatic atherosclerosis.2 Overall, the investigators in this registry enrolled 160 recently symptomatic patients with 50%–99% angiographic stenosis. Patients were followed for a median time of 5.4 months and the primary endpoint was stroke or death within 30 days of the procedure and stroke in the territory of the treated vessel thereafter. Several factors were associated with an increased risk for postprocedure major complications, including posterior circulation stenosis, stenting at a low enrollment site (fewer than 10 patients), stenting within 10 days of the last …