背景:在当代临床实践中,颈动脉支架置入术(CAS)正日益成为一个多专业领域,加入各种培训背景的运营商,带来了他们独特的专业知识,病人管理哲学,和程序偏好。最佳实践和方法,然而,仍在辩论。因此,对不同运营商偏好和相关结果的现实见解是最有价值的,但在现有文献中仍然相当稀缺。
方法:使用在ROADSAVER观测中收集的数据,欧洲多中心CAS研究,进行了预先指定的比较分析,评估操作员专业化的影响。我们在30天随访时使用主要不良事件(MAE)率,定义为任何死亡或中风的累积发生率,及其作为结果衡量标准的组成部分。
结果:总共分析了1965年的手术;几乎一半的878例(44.7%)由放射科医生(介入/神经)进行,717(36.5%)由心脏病学家或血管学家,外科医生(血管/神经)370人(18.8%)。由外科医生治疗的患者年龄最大(72.9±8.5),而放射科医生治疗大多数有症状的患者(58.1%),更经常使用放射状入路(37.2%)。心脏病专家/血管学家的30天MAE发生率为2.0%,放射科医生2.5%,和外科医生1.9%;观察到的比率差异在统计学上不显著(P=0.7027),即使根据基线患者/病变和组间手术差异进行了调整。任何原因死亡的相应发生率为1.0%,0.8%,0.3%,P=0.4880,对于任何中风:1.4%,2.3%,和1.9%,P分别为0.4477。
结论:尽管患者选择和程序偏好存在差异,不同专业在现实世界中取得的成果,当使用现代设备和技术时,当代CAS实践保持相似。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.