TY - JOUR
T1 - Influence of the interventionist's experience on outcomes of endovascular thrombectomy in acute ischemic stroke: results from the MR CLEAN Registry
AU - Olthuis, S.G.H.
AU - den Hartog, S.J.
AU - van Kuijk, S.M.J.
AU - Staals, J.
AU - Benali, F.
AU - van der Leij, C.
AU - Beumer, D.
AU - Nijeholt, G.J.L.A.
AU - Uyttenboogaart, M.
AU - Martens, J.M.
AU - Van Doormaal, P.J.
AU - Vos, J.A.
AU - Emmer, B.J.
AU - Dippel, D.W.J.
AU - van Zwam, W.H.
AU - van Oostenbrugge, R.J.
AU - de Ridder, I.R.
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
The MR CLEAN Registry was supported by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN); Erasmus MC University Medical Center; Maastricht University Medical Center+; and Amsterdam University Medical Center.
Funding Information:
DWJD reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC, and Cerenovus for research, all paid to the institution. DWJD participates in the DSMBs of ESCAPE-NEXT (stopped July 2021) and TESLAT (without receiving payments). WHvZ received consultation fees from Stryker, Nico Lab, and Cerenovus, paid to the institution. WHvZ participates in the DSMBs of Philips’WeTrust study, Anaconda’s Solonda study, in Extremis Studies, Montpellier, all funding was paid to the institution. BJE received grants from the Dutch Research Foundation (ZonMW), Dutch Ministery of Economy (TKI-PPP), and Nico Lab, all paid to the institution. CvdL participates in the Secretary Dutch Interventional Society (unpaid). SMJvK reports participation in DSMBs of multiple studies as a statistician, none in the same clinical field. JS participates in the executive committee of the MR CLEAN MED, unpaid. MU received grants from the Dutch Heart Foundation, paid to the CONTRAST consortium. MU also received financial support for interventional workshops and travel visits paid to Microvention, Stryker, Cerenovus. PJvD received consultation fees and payments/honoraria from Stryker, paid to the institution.
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/2
Y1 - 2023/2
N2 - Background: The relationship between the interventionist's experience and outcomes of endovascular thrombectomy (EVT) for acute ischemic stroke of the anterior circulation, is unclear. Objective: To assess the effect of the interventionist's level of experience on clinical, imaging, and workflow outcomes. Secondly, to determine which of the three experience definitions is most strongly associated with these outcome measures. Methods: We analysed data from 2700 patients, included in the MR CLEAN Registry. We defined interventionist's experience as the number of procedures performed in the year preceding the intervention (EXPfreq), total number of procedures performed (EXPno), and years of experience (EXPyears). Our outcomes were the baseline-adjusted National Institutes of Health Stroke Scale (NIHSS) score at 24-48 hours post-EVT, recanalization (extended Thrombolysis in Cerebral Infarction (eTICI) score ≥2B), and procedural duration. We used multilevel regression models with interventionists as random intercept. For EXPfreq and EXPno results were expressed per 10 procedures. Results: Increased EXPfreq was associated with lower 24-48 hour NIHSS scores (adjusted (a)β:-0.46, 95% CI -0.70 to -0.21). EXPno and EXPyears were not associated with short-term neurological outcomes. Increased EXPfreq and EXPno were both associated with recanalization (aOR=1.20, 95% CI 1.11 to 1.31 and aOR=1.08, 95% CI 1.04 to 1.12, respectively), and increased EXPfreq, EXPno, and EXPyears were all associated with shorter procedure times (aβ:-3.08, 95% CI-4.32 to -1.84; aβ:-1.34, 95% CI-1.84 to -0.85; and aβ:-0.79, 95% CI-1.45 to -0.13, respectively). Conclusions: Higher levels of interventionist's experience are associated with better outcomes after EVT, in particular when experience is defined as the number of patients treated in the preceding year. Every 20 procedures more per year is associated with approximately one NIHSS score point decrease, an increased probability for recanalization (aOR=1.44), and a 6-minute shorter procedure time.
AB - Background: The relationship between the interventionist's experience and outcomes of endovascular thrombectomy (EVT) for acute ischemic stroke of the anterior circulation, is unclear. Objective: To assess the effect of the interventionist's level of experience on clinical, imaging, and workflow outcomes. Secondly, to determine which of the three experience definitions is most strongly associated with these outcome measures. Methods: We analysed data from 2700 patients, included in the MR CLEAN Registry. We defined interventionist's experience as the number of procedures performed in the year preceding the intervention (EXPfreq), total number of procedures performed (EXPno), and years of experience (EXPyears). Our outcomes were the baseline-adjusted National Institutes of Health Stroke Scale (NIHSS) score at 24-48 hours post-EVT, recanalization (extended Thrombolysis in Cerebral Infarction (eTICI) score ≥2B), and procedural duration. We used multilevel regression models with interventionists as random intercept. For EXPfreq and EXPno results were expressed per 10 procedures. Results: Increased EXPfreq was associated with lower 24-48 hour NIHSS scores (adjusted (a)β:-0.46, 95% CI -0.70 to -0.21). EXPno and EXPyears were not associated with short-term neurological outcomes. Increased EXPfreq and EXPno were both associated with recanalization (aOR=1.20, 95% CI 1.11 to 1.31 and aOR=1.08, 95% CI 1.04 to 1.12, respectively), and increased EXPfreq, EXPno, and EXPyears were all associated with shorter procedure times (aβ:-3.08, 95% CI-4.32 to -1.84; aβ:-1.34, 95% CI-1.84 to -0.85; and aβ:-0.79, 95% CI-1.45 to -0.13, respectively). Conclusions: Higher levels of interventionist's experience are associated with better outcomes after EVT, in particular when experience is defined as the number of patients treated in the preceding year. Every 20 procedures more per year is associated with approximately one NIHSS score point decrease, an increased probability for recanalization (aOR=1.44), and a 6-minute shorter procedure time.
KW - stroke
KW - thrombectomy
KW - intervention
KW - PERCUTANEOUS CORONARY INTERVENTION
KW - LEARNING-CURVE
KW - MECHANICAL THROMBECTOMY
KW - INTRAARTERIAL TREATMENT
KW - OPERATOR EXPERIENCE
KW - UNITED-STATES
KW - VOLUME
KW - IMPACT
KW - THERAPY
U2 - 10.1136/neurintsurg-2021-018295
DO - 10.1136/neurintsurg-2021-018295
M3 - Article
C2 - 35058316
SN - 1759-8478
VL - 15
SP - 113
EP - 119
JO - Journal of Neurointerventional Surgery
JF - Journal of Neurointerventional Surgery
IS - 2
ER -