Learning curve during percutaneous treatment of carotid lesions

Background Percutaneous transluminal angioplasty (PTA) of the carotid artery with stent implantation is an effective procedure for the prevention of ischemic stroke but its periprocedural morbimortality is still subject to debate. Objective The aim of this study is to report the results of a prospective series of patients treated with PTA. Methods This is a descriptive, observational, prospective study using the database of three Hemodynamic centers in Buenos Aires, which included all patients submitted to PTA from January 1998 to December 2010. The results of PTA performed by the same operator were analyzed. Results Mean age was 69 years, 58% of the patients were men, 58.8% were smokers, 52% had dyslipidemia, 79.1% were hypertensive, and 28% had diabetes. Prior history of acute myocardial infarction and coronary surgery was present in 19.4 and 11.6% of the patients, respectively. From 1998 to 2004 (initial stage, n=54) 72% of symptomatic patients had indication of revascularization, which was performed without cerebral protection in all cases. During the most recent stage (2004-2010, n=171), only 17.5% of the patients were symptomatic and revascularization was performed systematically with cerebral protection. Similar angiographic success was obtained in both stages (initial 96% vs. recent 97%), whereas clinical success rate was greater in the recent phase (96.1% vs. 87%, p=0.016). There were no cardiac complications. The rate of death or intrahospital stroke was 4%, 4.3% (3/70) in symptomatic and 3.2% (5/155) in asymptomatic patients; moreover, this rate was higher in the initial than in the recent phase (11.1% [6/54] vs. 1.7% [2/171], p=0.0028).