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Stenting's Steep Learning Curve Linked to High Mortality Rates

Cheryl Clark, for HealthLeaders Media, September 30, 2011

Nallamothu noted that unlike other types of procedures that have been performed for longer periods, there is no professionally agreed upon standard for training requirements on the number of stenting procedures one must do under supervision before becoming the primary practitioner on the case.

Asked what he thinks the training requirements might be, he wrote in an e-mail that "no one knows for sure," although a coalition consisting of the Society for Cardiac Angiography, the Society for Vascular Medicine and the Society for Vascular Surgery suggests that a minimum of 25 procedures is required, with half as primary operator.

Use of carotid artery stents, designed to prevent stroke, was approved by the U.S. Food and Drug Administration in 2004 as a less invasive alternative to carotid artery surgery or endartarectomy. Since then, use of the practice has more than doubled.

It can be done without general anesthesia, and operators include cardiologists, radiologists, and general surgeons.

In an accompanying editorial, Ethan Halm, MD, of the Departments of General Internal Medicine and Clinical Sciences of the University of Texas Southwestern Medical Center in Dallas, noted that in clinical practice, mortality rates seem to be more than twice the mortality rate in CREST, the Carotid Revascularization Endartarectomy vs. Stenting Trial that led to the procedure's approval.

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