Appropriate patient and lesion selection is essential to optimize outcome. Participation in educational programs devoted to the specific device is also necessary. Maintenance of competence. After initial training, maintenance of competence is critically important. The number of cases required for maintenance of competence depends on the operator's overall experience as well as the complexity of the procedure.
More complex procedures using non-balloon devices require a greater level of continued experience.
Every attempt should be made to concentrate the experience of these more complex and less frequently performed procedures in the hands of a small number of higher volume interventionalists. Maintenance of competence should require that patient outcome be determined longitudinally for each procedure by the institution's quality assessment program, which includes performance evaluation and feedback to the operator. These devices are often more demanding to use than conventional balloon technology and are often used in patients with more complex and riskier clinical circumstances. The ability to use stents to treat acute or threatened closure is an essential skill for all interventional cardiologists. Other procedures, such as DCA and rotational atherectomy, can be used as part of a preplanned strategy.