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Zhu F, Ben Hassen W, Bricout N, Kerleroux B, Janot K, Gory B, Anxionnat R, Richard S, Marchal A, Blanc R, Piotin M, Consoli A, Trystram D, Rodriguez Regent C, Desilles JP, Weisenburger-Lile D, Escalard S, Herbreteau D, Ifergan H, Lima Maldonado I, Labreuche J, Henon H, Naggara O, Lapergue B, Boulouis G. Effect of Operator's Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study. Stroke 2021; 52:2736-2742. [PMID: 34233462 DOI: 10.1161/strokeaha.120.031940] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate among trained interventional neuroradiologist, whether increasing individual experience was associated with an improvement in mechanical thrombectomy (MT) procedural performance metrics. METHODS Individual MT procedural data from 5 centers of the Endovascular Treatment in Ischemic Stroke registry and 2 additional high-volume stroke centers were pooled. Operator experience was defined for each operator as a continuous variable, cumulating the number of MT procedures performed since January 2015, as MT became standard of care or, if later than this date, since the operator started performing mechanical thrombectomies in autonomy. We tested the associations between operator's experience and procedural metrics. RESULTS A total of 4516 procedures were included, performed by 36 operators at 7 distinct centers, with a median of 97.5 endovascular treatment procedures per operator (interquartile range, 57-170.2) over the study period. Higher operator's experience, analyzed as a continuous variable, was associated with a significantly shorter procedural duration (β estimate, -3.98 [95% CI, -5.1 to -2.8]; P<0.001), along with local anesthesia and M1 occlusion location in multivariable models. Increasing experience was associated with better Thrombolysis in Cerebral Infarction scores (estimate, 1.02 [1-1.04]; P=0.013). CONCLUSIONS In trained interventional neuroradiologists, increasing experience in MT is associated with significantly shorter procedural duration and better reperfusion rates, with a theoretical ceiling effect observed after around 100 procedures. These results may inform future training and practice guidelines to set minimal experience standards before autonomization, and to set-up operators' recertification processes tailored to individual case volume and prior experience.
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Affiliation(s)
- François Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.)
| | - Wagih Ben Hassen
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.)
| | - Nicolas Bricout
- Department of Neuroradiology, CHRU Lille, France (N.B., A.M.)
| | - Basile Kerleroux
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).,Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
| | - Kevin Janot
- Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.)
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, F-54000, CHRU Nancy and IADI, INSERM U1254, F-54000, Université de Lorraine, Nancy, France (F.Z., B.G., R.A.)
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, CHRU Nancy and INSERM U1116, F-54000, Université de Lorraine, Nancy, France (S.R.)
| | - Adrien Marchal
- Department of Neuroradiology, CHRU Lille, France (N.B., A.M.)
| | - Raphael Blanc
- Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.)
| | - Michel Piotin
- Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.)
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France (A.C.)
| | - Denis Trystram
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.)
| | - Christine Rodriguez Regent
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.)
| | - Jean-Philippe Desilles
- Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.)
| | | | - Simon Escalard
- Department of Neuroradiology, Fondation Ophtalmologique A. de Rothschild, Paris, France (R.B., M.P., J.-P.D., S.E.)
| | - Denis Herbreteau
- Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
| | - Heloise Ifergan
- Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
| | | | - Julien Labreuche
- CHRU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, Lille, France (J.L.)
| | - Hilde Henon
- Department of Neurology, Stroke Unit, CHRU Lille, Lille, France (H.H.)
| | - Olivier Naggara
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.)
| | - Bertrand Lapergue
- Department of Neurology, Stroke Unit, Foch Hospital, Suresnes, France (D.W.-L., B.L.)
| | - Grégoire Boulouis
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris (W.B.H., B.K., D.T., C.R.R., O.N., G.B.).,Department of Neuroradiology, CHRU Tours, Tours, France (B.K., K.J., D.H., H.I., G.B.)
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