Initial experience in establishing an academic neuroendovascular service: Program building, procedural types, and outcomes

OBJECTIVE: To report our initial experience in setting up a neuroendovascular service in a university-based comprehensive stroke center. METHODS: We determined the rates of referral path, procedural type, and independently adjudicated 1-month outcomes (actual rates) in first 150 procedures (120 patients) and subsequently compared with rates derived from pertinent clinical trials after adjustment for procedural type (predicted rates). RESULTS: The patients were referred from the emergency department (n = 44), transferred from another hospital (n = 13), or admitted for elective procedures from the clinic (n = 63). The procedures included treatment of acute ischemic stroke (n = 12); extracranial carotid stent placement (n = 33); extracranial vertebral artery stent placement (n = 13); intracranial angioplasty and/or stent placement (n = 12); embolization for intracranial aneurysms (n = 35), arteriovenous malformations (n = 5), and tumors (n = 10); cerebral vasospasm treatment (n = 26); and others (n = 4). The technical success rate was 100% for intracranial aneurysm obliteration and extracranial carotid artery stent placement, and 95% for those undergoing intracranial or vertebral artery stent placements; and partial or complete recanalization was achieved in 72% of patients undergoing intra-arterial thrombolysis. After adjusting for procedural type, the actual adverse event rate of 3% compared favorably with the predicted rate of 7% based on the results of clinical trials. CONCLUSIONS: We provide estimates of procedure volumes and outcomes observed in the initial phase of setting up a neuroendovascular service with an active training program.