Effect of Operator’s Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study
François Zhu, Wagih Ben Hassen, Nicolas Bricout, Basile Kerleroux, Kévin Janot, Benjamin Gory, René Anxionnat, Sébastien Richard, Adrien Marchal, Raphaël Blanc, Michel Piotin, Arturo Consoli, D. Trystram, Christine Rodriguez-Régent, Jean‐Philippe Desilles, David Weisenburger‐Lile, Simon Escalard, Denis Herbreteau, Héloïse Ifergan, Igor Lima Maldonado, Julien Labreuche, Hilde Hénon, Olivier Naggara, Bertrand Lapergue, Grégoire Boulouis, Hocine Redjem, Gabriele Cicciò, Smajda Stanislas, Benjamin Maïer, Mazighi Mikael, Mikael Obadia, Candice Sabben, Peres Roxanne, Ovide Corabianu, De Broucker Thomas, Didier Smadja, Sonia Alamowitch, Olivier Ille, Eric Manchon, Pierre‐Yves Garcia, Taylor Guillaume, Ben Maacha Malek, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Di Maria Federico, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Rakotoharinandrasana Haja, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Norbert Nighoghossian, Roberto Riva, Eker Omer, Françis Turjman, Derex Laurent, Cho Tae‐Hee, Laura Mechtouff, Claire Lukaszewicz Anne, Philippeau Frédéric, Serkan Cakmak, Karine Blanc‐Lasserre, Anne‐Evelyne Vallet, Marnat Gaultier, Florent Gariel, Xavier Barreau, Berge Jérôme, Patrice Menegon, Igor Sibon, L Sebastien, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Poli Mathilde, Sabrina Debruxelles, Nicolas Pangon, Romain Bourcier, Lili Détraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Vincent L’Allinec, Girot Jean-Baptiste, Desal Hubert, Serge Bracard, Marc Braun, Anne‐Laure Derelle, Tonnelet Romain, Liang Liao, Patricio Muszynski, Schmitt Emmanuelle
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.