Neurointerventional Procedural Complications in a Growing Canadian Regional Stroke Center: Single Hospital Experience Analysis in the Context of Recommended Case Volumes

World Neurosurg. 2019 Jul:127:e94-e100. doi: 10.1016/j.wneu.2019.02.137. Epub 2019 Mar 6.

Abstract

Background: Evidence continues to emerge regarding the inverse relationship between high neurointerventional case volume and complication rates, leading several medical/surgical societies to recommend minimum volumes for specific procedures. Recent data suggest few centers are meeting these requirements. We report a single center's neurointerventional complication rates with associated case volumes, along with a review of the literature.

Methods: A retrospective cohort review of all consecutive patients undergoing diagnostic catheter cerebral angiography and/or neurointerventional procedures between January 1, 2013, and March 1, 2018, was undertaken. No diagnostic or interventional procedures were excluded. All major and minor complications were recorded.

Results: A total of 1000 procedures (463 diagnostic cerebral angiograms and 537 neurointerventional procedures) were completed. Of the neurointerventional procedures, 216 (40%) were endovascular thrombectomy, 170 (32%) were aneurysmal embolization, and 48 (9%) were carotid stenting. The mean and median age was 60 years. There were 460 women and 540 men. The total number of major complications for diagnostic angiography, endovascular thrombectomy, ruptured aneurysm embolization, unruptured aneurysm embolization, and carotid artery stenting were 4 (0.9%), 4 (1.9%), 10 (11%), 4 (5.4%), and 3 (6.3%), respectively.

Conclusions: We provided a single-center experience of the relationship between neurointerventional procedural case volume and complication rates in the growth phase of our center's establishment. We demonstrated that as our center was being developed, specific procedural staffing measures allowed proficiency maintenance, acquisition of new techniques, and complication avoidance, whereas specific case volumes crossed the suggested thresholds as defined in the literature.

Keywords: Aneurysm; Carotid; Case volume; Complications; Neurointerventional; Stroke.

Publication types

  • Review

MeSH terms

  • Aged
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / surgery
  • Canada / epidemiology
  • Cerebral Angiography / adverse effects*
  • Embolization, Therapeutic / adverse effects*
  • Endovascular Procedures / adverse effects
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery
  • Intracranial Aneurysm / therapy
  • Male
  • Middle Aged
  • Neuroimaging
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Stents
  • Stroke / surgery
  • Thrombectomy / adverse effects*
  • Trauma Centers / statistics & numerical data