Aims and scope

Procedural time, quality of reperfusion and number of passes are known prognosis factors for patients with acute ischemic stroke due to large vessel occlusion strokes treated by mechanical thrombectomy (MT) [1], [2], [3]. These procedural efficiency metrics are known to vary with various factors, amongst which operator's previous endo-vascular experience as well as center annual procedural volume [4]. We aimed to evaluate amongst trained interventional neuroradiologist (INR), whether increasing experience was associated with an improvement in MT procedural performance metrics.

Material and method

This retrospective cohort study pooled MT procedural data across 3 high volume academic comprehensive stroke centers. Main study endpoints were duration of procedure, final angiographic recanalisation according to mTICI classification, number of passes, rate of first-pass complete recanalisation and rate of arterial perforation. Operator experience was defined for each operator as a continuous variable, cumulating the number of mechanical thrombectomy procedures performed since January 2015 or, if ulterior, since the operator started performing mechanical thrombectomies. Experience > 2 years as a senior INR before 2015 was rated as a nominal variable.

Results

A total of 1872 patients were included, treated by 14 operators (Mean 133 MT/operator, min 57 max 218). After adjustment for age, IV thrombolysis, on vs. off hours and occlusion location, increasing operator experience was significantly associated with shortened procedure duration. (Beta −3,50; 95% CI [−5.03 to −1.98]; P < 0.001, See Fig. 1). Previous experience > 2 years in INR was also associated with shorter procedural duration. No significant association was found between increasing operator experience and successful reperfusion (mTICI 2b-3), number of passes or first pass recanalisation rates.

Conclusion

In trained interventional neuroradiologists, increasing experience in mechanical thrombectomy is associated with significantly shorter procedural duration. Whether these delays reductions translate to better clinical outcomes should be investigated in larger scale registries. These results may inform future training guidelines to set minimal experience standards before seniorisation.

中文翻译：

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机械血栓切除术中操作者经验与手术时间之间的关联

目的和范围

对于因机械性血栓切除术（MT）治疗的大血管闭塞性卒中而导致的急性缺血性卒中，手术时间，再灌注质量和通过次数是已知的预后因素[1]，[2]，[3]。众所周知，这些程序效率指标会随各种因素而变化，其中包括操作员以前的血管内经验以及中心年度程序量[4]。我们旨在评估训练有素的介入神经放射科医生（INR）中是否增加的经验与MT程序性能指标的改善有关。

材料和方法

这项回顾性队列研究汇总了3个大容量学术综合性卒中中心的MT程序数据。主要研究终点是手术时间，根据mTICI分类进行的最终血管造影再通，通行次数，首次通行完全再通率和动脉穿孔率。每个操作员的操作员经验定义为一个连续变量，累加自2015年1月或自操作员开始执行机械血栓切除术以来进行的机械血栓切除术手术的次数。在2015年之前有超过2年的高级INR经验被评为名义变量。

结果

总共纳入了1872名患者，由14名操作员进行了治疗（平均133 MT /操作员，最小57最大218）。在调整了年龄，静脉溶栓，上班时间，下班时间和阻塞位置之后，增加操作者经验与缩短手术时间显着相关。（β-3,50； 95％CI [-5.03至-1.98]；P  <0.001，见图1）。过去2年以上的INR经验也与手术时间较短有关。在增加操作者经验与成功的再灌注（mTICI 2b-3），通过次数或首次通过再通率之间没有发现显着关联。

结论

在训练有素的介入神经放射科医生中，机械血栓切除术经验的增加与手术时间的明显缩短有关。这些延误的减少是否可以转化为更好的临床结果，应该在较大规模的注册机构中进行调查。这些结果可能会为将来的培训指南提供参考，以在高级化之前设置最低限度的经验标准。