Impact of Operator and Site Experience on Outcomes after Angioplasty and Stenting in the SAMMPRIS Trial

Colin P Derdeyn; David Fiorella; Michael J Lynn; Stan L Barnwell; Osama O Zaidat; Philip Meyers; Y. Pierre Gobin; Jaques Dion; Bethany F Lane; Tanya N Turan; L Scott Janis; Marc I Chimowitz

doi:10.1136/neurintsurg-2012-010504

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Impact of Operator and Site Experience on Outcomes after Angioplasty and Stenting in the SAMMPRIS Trial

Journal article

Peer reviewed

Impact of Operator and Site Experience on Outcomes after Angioplasty and Stenting in the SAMMPRIS Trial

Colin P Derdeyn, David Fiorella, Michael J Lynn, Stan L Barnwell, Osama O Zaidat, Philip Meyers, Y. Pierre Gobin, Jaques Dion, Bethany F Lane, Tanya N Turan, …

Journal of neurointerventional surgery, Vol.5(6), pp.528-533

11/01/2013

DOI: 10.1136/neurintsurg-2012-010504

PMCID: PMC3652908

PMID: 22977278

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Abstract

Abstract Background and purpose To investigate the relationship between physician and site experience and the risk of 30 day hemorrhagic and ischemic strokes in the stenting arm of the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial. Methods Study records and an investigator survey were examined for physician and site related factors, including: number of Wingspan and aneurysm stents submitted for credentialing, number of study procedures performed in SAMMPRIS, years in practice after training, primary specialty, and site enrollment. Bivariate and multivariate analyses were performed to determine if these factors were associated with the 30 day rate of cerebrovascular events after angioplasty and stenting. Results 213 patients underwent angioplasty alone (n=5) or angioplasty and stenting (n=208) with study devices by 63 interventionists at 48 sites. For credentialing, the median number of Wingspan and similar aneurysm stent cases submitted by study interventionists were 10 and 6, respectively. Interventionists with higher numbers (>10) of Wingspan cases submitted for credentialing tended to have higher rates of 30 day events (19.0% vs 9.9%) than those with <10 cases. High enrolling sites in the trial tended to have lower rates of hemorrhagic stroke (9.8% at sites enrolling <12 patients vs 2.7% at sites enrolling >12 patients). Conclusions Interventionists credentialed with less Wingspan experience were not responsible for the high rate of periprocedural stroke in SAMMPRIS. Hemorrhagic stroke may be related to low enrollment in the trial but not previous Wingspan experience.

clinical trial

angioplasty and stenting

Intracranial stenosis

Details

Title: Subtitle: Impact of Operator and Site Experience on Outcomes after Angioplasty and Stenting in the SAMMPRIS Trial
Creators: Colin P Derdeyn - Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery, Washington University School of Medicine, St Louis MO
David Fiorella - Department of Neurosurgery, State University of New York, Stony Brook, NY
Michael J Lynn - Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA
Stan L Barnwell - Department of Neurological Surgery and the Dotter Interventional Institute, Oregon Health Sciences University, Portland, OR
Osama O Zaidat - Departments of Neurology, Radiology, and Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
Philip Meyers - Department of Radiology, Columbia University, New York, NY
Y. Pierre Gobin - Department of Radiology, Cornell University, New York, NY
Jaques Dion - Department of Radiology and Neurosurgery, Emory University, Atlanta, GA
Bethany F Lane - Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA
Tanya N Turan - Department of Neurosciences, Medical University of South Carolina, Charleston, SC
L Scott Janis - National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD
Marc I Chimowitz - Department of Neurosciences, Medical University of South Carolina, Charleston, SC
Resource Type: Journal article
Publication Details: Journal of neurointerventional surgery, Vol.5(6), pp.528-533
DOI: 10.1136/neurintsurg-2012-010504
PMID: 22977278
PMCID: PMC3652908
NLM abbreviation: J Neurointerv Surg
ISSN: 1759-8478
eISSN: 1759-8486
Grant note: UL1 RR024131 || RR / National Center for Research Resources : NCRR U01 NS058728 || NS / National Institute of Neurological Disorders and Stroke : NINDS UL1 TR000062 || TR / National Center for Advancing Translational Sciences : NCATS TL1 RR029889 || RR / National Center for Research Resources : NCRR K23 NS069668 || NS / National Institute of Neurological Disorders and Stroke : NINDS UL1 TR000077 || TR / National Center for Advancing Translational Sciences : NCATS
Language: English
Date published: 11/01/2013
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984018542402771

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