Effect of Operator’s Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study
Authors: Zhu François , Ben Hassen Wagih , Bricout Nicolas , Kerleroux Basile , Janot Kevin , Gory Benjamin , Anxionnat René , Richard Sébastien , Marchal Adrien , Blanc Raphael , Piotin Michel , Consoli Arturo , Trystram Denis , Rodriguez Regent Christine , Desilles Jean-Philippe , Weisenburger-Lile David , Escalard Simon , Herbreteau Denis , Ifergan Heloise , Lima Maldonado Igor , Labreuche Julien , Henon Hilde , Naggara Olivier , Lapergue Bertrand , Boulouis Grégoire , Hocine Redjem , Gabriele Ciccio , Stanislas Smajda , Benjamin Maier , Mikael Mazighi , Mikael Obadia , Candice Sabben , Roxanne Peres , Ovide Corabianu , Thomas De Broucker , Didier Smadja , Sonia Alamowitch , Olivier Ille , Eric Manchon , Pierre-Yves Garcia , Guillaume Taylor , Malek Ben Maacha , Adrien Wang , Serge Evrard , Maya Tchikviladze , Nadia Ajili , Lucas Gorza , Géraldine Buard , Oguzhan Coskun , Maria Federico Di , Georges Rodesh , Sergio Zimatore , Morgan Leguen , Julie Gratieux , Fernando Pico , Haja Rakotoharinandrasana , Philippe Tassan , Roxanna Poll , Sylvie Marinier , Norbert Nighoghossian , Roberto Riva , Omer Eker , Francis Turjman , Laurent Derex , Tae-Hee Cho , Laura Mechtouff , Lukaszewicz Anne Claire , Frédéric Philippeau , Serkan Cakmak , Karine Blanc-Lasserre , Anne-Evelyne Vallet , Gaultier Marnat , Florent Gariel , Xavier Barreau , Jérôme Berge , Patrice Menegon , Igor Sibon , Sebastien Liegey , Stéphane Olindo , Pauline Renou , Sharmila Sagnier , Mathilde Poli , Sabrina Debruxelles , Nicolas Pangon , Romain Bourcier , Lili Detraz , Benjamin Daumas-Duport , Pierre-Louis Alexandre , Monica Roy , Cédric Lenoble , Vincent L’allinec , Jean-Baptiste Girot , Hubert Desal , Serge Bracard , Marc Braun , Anne-Laure Derelle , Romain Tonnelet , Liang Liao , Patricio Muszynski , Emmanuelle Schmitt , Sophie Planel , Lisa Humbertjean , Gioia Mione , Jean-Christophe Lacour , Nolwenn Riou-Comte , Gérard Audibert , Marcela Voicu , Ionel Alb , Marie Reitter , Madalina Brezeanu , Agnès Masson , Ioana Tabarna Adriana, Podar , Francisco Macian-Montoro , Suzanna Saleme , Charbel Mounayer , Aymeric Rouchaud , Vincent Costalat , Caroline Arquizan , Cyril Dargazanli , Grégory Gascou , Pierre-Henri Lefèvre , Imad Derraz , Carlos Riquelme , Nicolas Gaillard , Isabelle Mourand , Lucas Corti , Eugene Francois , Stéphane Vannier , Jean-Christophe Ferre , Helene Raoult , Thomas Ronziere , Maria Lassale , Christophe Paya , Jean-Yves Gauvrit , Clément Tracol , Sophie Langnier-Lemercier , Yves Samson , Charlotte Rosso , Anne Leger , Sandrine Deltour , Frederic Clarencon , Eimad Shotar , Laurent Spelle , Christian Denier , Olivier Chassin , Vanessa Chalumeau , Jildaz Caroff , Olivier Chassin , Laura Venditti , Guillaume Turc , Pierre Seners , Valérie Domigo , Catherine Lamy , Julia Birchenall , Clothilde Isabel , Alain Viguier , Christophe Cognard , Anne Christine Januel , Jean-Marc Olivot , Nicolas Raposo , Fabrice Bonneville , Albucher Jean François , Lionel Calviere , Emmanuel Touze , Charlotte Barbier , Romain Schneckenburger , Marion Boulanger , Julien Cogez , Sophie Guettier , Serge Timsit , Jean-Christophe Gentric , Julien Ognard , Francois Mathias Merrien , Ozlem Ozkul Wermester , Evelyne Massardier , Chrysanthi Papagiannaki , Frédéric Bourdain , Bernady Patricia , Laurent Lagoarde-Segot , Hélène Cailliez , Louis Veunac , David Higue , Valérie Wolff , Raoul Pop , Rémi Beaujeux , Dan-Sorin Mihoc , Monica Manisor , Anthony Le Bras , Sarah Evain , Arnaud Le Guen , Sebastian Richter , Regis Hubrecht , Stéphanie Demasles , Bruno Barroso , Mathieu Zuber , Wassim Farhat , Quentin Alias , François Lun , Delphine Stenvenoot , Olivier Heinzlef , Sylvie Godon Hardy , Valentin Bohotin , Jérôme Grimaud 
Published: July 2021

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.