Learning curves for transradial access versus transfemoral access in diagnostic cerebral angiography: a case series

2021 ◽  
pp. neurintsurg-2021-017460
Author(s):  
Michael K Tso ◽  
Gary B Rajah ◽  
Rimal H Dossani ◽  
Michael J Meyer ◽  
Matthew J McPheeters ◽  
...  
Keyword(s):  
Learning Curve ◽  
Case Series ◽  
Learning Curves ◽  
Fluoroscopy Time ◽  
Access Site ◽  
Steep Learning Curve ◽  
Transradial Access ◽  
Primary Operator ◽  
Technical Proficiency ◽  
Over Time

BackgroundThe perception of a steep learning curve associated with transradial access has resulted in its limited adoption in neurointervention despite the demonstrated benefits, including decreased access-site complications.ObjectiveTo compare learning curves of transradial versus transfemoral diagnostic cerebral angiograms obtained by five neurovascular fellows as primary operator.MethodsThe first 100–150 consecutive transradial and transfemoral angiographic scans performed by each fellow between July 2017 and March 2020 were identified. Mean fluoroscopy time per artery injected (angiographic efficiency) was calculated as a marker of technical proficiency and compared for every 25 consecutive procedures performed (eg, 1–25, 26–50, 51–75).ResultsWe identified 1242 diagnostic angiograms, 607 transradial and 635 transfemoral. The radial cohort was older (64.3 years vs 62.3 years, p=0.01) and demonstrated better angiographic efficiency (3.4 min/vessel vs 3.7 min/vessel, p=0.03). For three fellows without previous endovascular experience, proficiency was obtained between 25 and 50 transfemoral angiograms. One fellow achieved proficiency after performing 25–50 transradial angiograms; and the two other fellows, in <25 transradial angiograms. The two fellows with previous experience had flattened learning curves for both access types. Two patients experienced transient neurologic symptoms postprocedure. Transradial angiograms were associated with significantly fewer access-site complications (3/607, 0.5% vs 22/635, 3.5%, p<0.01). Radial-to-femoral conversion occurred in 1.2% (7/607); femoral-to-radial conversion occurred in 0.3% (2/635). Over time, the proportion of transradial angiographic procedures increased.ConclusionTechnical proficiency improved significantly over time for both access types, typically requiring between 25 and 50 diagnostic angiograms to achieve asymptomatic improvement in efficiency. Reduced access-site complications and decreased fluoroscopy time were benefits associated with transradial angiography.

Comparison of Transradial vs Transfemoral Access in Neurovascular Fellowship Training: Overcoming the Learning Curve

2021 ◽  
Author(s):  
Fadi Al Saiegh ◽  
Ahmad Sweid ◽  
Nohra Chalouhi ◽  
Lucas Philipp ◽  
Nikolaos Mouchtouris ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Learning Curve ◽  
Fellowship Training ◽  
Learning Curves ◽  
Fluoroscopy Time ◽  
Site Infection ◽  
Procedure Time ◽  
Access Site ◽  
Contrast Volume ◽  
Set Up

Abstract BACKGROUND The transradial access (TRA) is rapidly gaining popularity for neuroendovascular procedures as there is strong evidence for its benefits compared to the traditional transfemoral access (TFA). However, the transition to TRA bears some challenges including optimization of the interventional suite set-up and workflow as well as its impact on fellowship training. OBJECTIVE To compare the learning curves of TFA and TRA for diagnostic cerebral angiograms in neuroendovascular fellowship training. METHODS We prospectively collected diagnostic angiogram procedural data on the performance of 2 neuroendovascular fellows with no prior endovascular experience who trained at our institution from July 2018 until June 2019. Metrics for operator proficiency were minutes of fluoroscopy time, procedure time, and volume of contrast used. RESULTS A total of 293 diagnostic angiograms were included in the analysis. Of those, 57.7% were TRA and 42.3% were TFA. The median contrast dose was 60 cc, and the median radiation dose was 14 000 μGy. The overall complication rate was 1.4% consisting of 2 groin hematomas, 1 wrist hematoma, and 1 access-site infection using TFA. The crossover rate to TFA was 2.1%. Proficiency was achieved after 60 femoral and 95 radial cases based on fluoroscopy time, 52 femoral and 77 radial cases based on procedure time, and 53 femoral and 64 radial cases based on contrast volume. CONCLUSION Our study demonstrates that the use of TRA can be safely incorporated into neuroendovascular training without causing an increase in complications or significantly prolonging procedure time or contrast use.

Investigating the learning curve in endoscopic compared to microscopic myringotomy and ventilation tube insertion

2020 ◽  
Vol 134 (6) ◽  
pp. 497-500
Author(s):  
O Denton ◽  
A Daglish ◽  
L Smallman ◽  
S Fishpool
Keyword(s):  
Learning Curve ◽  
Learning Curves ◽  
Learning Rate ◽  
Middle Ear Surgery ◽  
Ventilation Tube ◽  
Ear Surgery ◽  
Steep Learning Curve ◽  
Learning Rates ◽  
Significant Difference ◽  
Rate Of Learning

AbstractObjectiveRate of learning is often cited as a deterrent in the use of endoscopic ear surgery. This study investigated the learning curves of novice surgeons performing simulated ear surgery using either an endoscope or a microscope.MethodsA prospective multi-site clinical research study was conducted. Seventy-two medical students were randomly allocated to the endoscope or microscope group, and performed 10 myringotomy and ventilation tube insertions. Trial times were used to produce learning curves. From these, slope (learning rate) and asymptote (optimal proficiency) were ascertained.ResultsThere was no significant difference between the learning curves (p = 0.41). The learning rate value was 68.62 for the microscope group and 78.71 for the endoscope group. The optimal proficiency (seconds) was 32.83 for the microscope group and 27.87 for the endoscope group.ConclusionThe absence of a significant difference shows that the learning rates of each technique are statistically indistinguishable. This suggests that surgeons are not justified when citing ‘steep learning curve’ in arguments against the use of endoscopes in middle-ear surgery.

scholarly journals The dynamics of syntax acquisition: facilitation between syntactic structures

2010 ◽  
Vol 38 (2) ◽  
pp. 404-432 ◽  
Author(s):  
TAMAR KEREN-PORTNOY ◽  
MICHAEL KEREN
Keyword(s):  
Regression Analysis ◽  
Learning Curve ◽  
First Language ◽  
Learning Curves ◽  
Syntactic Structures ◽  
Syntax Acquisition ◽  
Over Time

ABSTRACTThis paper sets out to show how facilitation between different clause structures operates over time in syntax acquisition. The phenomenon of facilitation within given structures has been widely documented, yet inter-structure facilitation has rarely been reported so far. Our findings are based on the naturalistic production corpora of six toddlers learning Hebrew as their first language. We use regression analysis, a method that has not been used to study this phenomenon. We find that the proportion of errors among the earliest produced clauses in a structure is related to the degree of acceleration of that structure's learning curve; that with the accretion of structures the proportion of errors among the first clauses of new structures declines, as does the acceleration of their learning curves. We interpret our findings as showing that learning new syntactic structures is made easier, or facilitated, by previously acquired ones.

scholarly journals Comparison of Procedure and Fluoroscopy Time Between Left Bundle Branch Area Pacing and Right Ventricular Pacing for Bradycardia: The Learning Curve for the Novel Pacing Strategy

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhao Wang ◽  
Haojie Zhu ◽  
Xiaofei Li ◽  
Yan Yao ◽  
Zhimin Liu ◽  
...  
Keyword(s):  
Learning Curve ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Learning Curves ◽  
Fluoroscopy Time ◽  
Ventricular Pacing ◽  
Success Rates ◽  
Right Ventricular Pacing ◽  
Ventricular Lead ◽  
Median Procedure

Background: Left bundle branch area pacing (LBBAP) is a novel physiological pacing approach.Objective: To assess learning curve for LBBAP and compare the procedure and fluoroscopy time between LBBAP and right ventricular pacing (RVP).Methods: Consecutive bradycardia patients who underwent LBBAP or RVP were prospectively recruited from June 2018 to June 2020. The procedure and fluoroscopy time for ventricular lead placement, pacing parameters, and periprocedural complications were recorded. Restricted cubic splines were used to fit learning curves for LBBAP.Results: Left bundle branch area pacing was successful in 376 of 406 (92.6%) patients while 313 patients received RVP. Learning curve for LBBAP illustrated initial (1–50 cases), improved (51–150 cases), and stable stages (151–406 cases) with gradually increased success rates (88.0 vs. 90.0 vs. 94.5%, P = 0.106), steeply decreased median procedure (26.5 vs. 14.0 vs. 9.0min, P &lt; 0.001) and fluoroscopy time (16.0 vs. 6.0 vs. 4.0min, P &lt; 0.001), and shortened stimulus to left ventricular activation time (Sti-LVAT; 78.7 vs. 78.1 vs. 71.2 ms, P &lt; 0.001). LBBAP at the stable stage showed longer but close median procedure (9.0 vs. 6.9min, P &lt; 0.001) and fluoroscopy time (4.0 vs. 2.8min, P &lt; 0.001) compared with RVP.Conclusion: The procedure and fluoroscopy time of LBBAP could be reduced significantly with increasing procedure volume and close to that of RVP for an experienced operator.

scholarly journals Transradial access for flow diversion of intracranial aneurysms: Case series

2020 ◽  
pp. 159101992093896
Author(s):  
Muhammad Waqas ◽  
Kunal Vakharia ◽  
Rimal H Dossani ◽  
Gary B Rajah ◽  
Michael K Tso ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Case Series ◽  
Left Common Carotid Artery ◽  
Flow Diversion ◽  
Access Site ◽  
Pipeline Embolization Device ◽  
Transradial Access

Background Transradial access for neurointerventions offers advantages of fewer access-site complications, reduced procedure time, and greater patient comfort over transfemoral access. Data about transradial access for flow diversion are limited. We share our early experience with transradial access for flow diversion in a relatively large case series. Methods Consecutive patients who underwent Pipeline embolization device (Medtronic) deployment via transradial access were included in the study, irrespective of location and laterality of the intracranial aneurysm. The cases were performed between July 2016 and October 2019. Demographics, aneurysm characteristics, and procedure-related details (including catheter systems used) were recorded and statistically evaluated. Results Thirty-five transradial flow diversion procedures were attempted in 32 patients, of which 33 procedures were successful. In two cases involving left common carotid artery and internal carotid artery access, guide catheter herniation into the aortic arch led to abandonment of transradial access in favor of transfemoral access. The most common aneurysm locations in the transradial access procedures were the posterior communicating artery ( n = 7), ophthalmic artery ( n = 7), and superior hypophyseal artery ( n = 7). Most transradial access procedures (66.7%) were performed using a biaxial catheter system. 6-French Benchmark (Penumbra) and Phenom 27 (Medtronic) were the most commonly utilized guide- and microcatheters, respectively. One patient had intraprocedural subarachnoid hemorrhage. No access-site complications occurred. Conclusion This study demonstrates safety and feasibility of transradial access for Pipeline embolization device deployment and shows the versatility of this approach for different catheter systems. Tortuosity and acute angulation of the left common carotid artery and internal carotid artery were associated with approach failure.

Use of a sheathless 8-French balloon guide catheter (Walrus) through the radial artery for mechanical thrombectomy: technique and case series

2021 ◽  
pp. neurintsurg-2021-017868
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Andre Monteiro ◽  
Justin M Cappuzzo ◽  
Faisal Almayman ◽  
...  
Keyword(s):  
Radial Artery ◽  
Mechanical Thrombectomy ◽  
Descriptive Analysis ◽  
Case Series ◽  
Retrospective Case ◽  
Access Site ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Transradial Access ◽  
Guide Catheter

BackgroundThe effectiveness of transradial stroke thrombectomy has been limited by guide catheter size and lack of good balloon options. In this study we describe our technique for the use of a sheathless 8-French balloon guide catheter (Walrus) through radial access and present our initial clinical experience.MethodsThis was a retrospective case series of consecutive patients who underwent mechanical thrombectomy for large vessel occlusion using the sheathless catheter over a period of 3 months. Clinical characteristics, procedural details, reperfusion success (modified Thrombolysis in Cerebral Infarction (mTICI) 2b–3 grade), first-pass effect (FPE; mTICI reperfusion grade 2c or 3 with a single pass), access site complications and clinical improvement at discharge were recorded. A descriptive analysis was performed.ResultsAmong the 10 patients in the series, median age was 77 years (IQR 75–79) and three were women. All patients had a baseline modified Rankin Scale score ≤2. Median admission National Institutes of Health Stroke Scale (NIHSS) score was 12.5 (IQR 9–16). Four patients received intravenous alteplase before mechanical thrombectomy. Eight patients had M1 occlusion and two had proximal M2 occlusion. The median radial artery diameter was 2.5 mm (IQR 2.5–2.7). Successful reperfusion was achieved in all patients. FPE was achieved in six patients. No access site-related complications or post-procedural intracranial hemorrhages occurred. All patients had improvement in NIHSS score at discharge.ConclusionsThe use of this sheathless catheter for transradial access was safe and feasible. The technique can potentially improve the outcomes of transradial access for stroke intervention.

scholarly journals Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula

2022 ◽  
Vol 52 (1) ◽  
pp. E3
Keyword(s):  
Systematic Review ◽  
Learning Curve ◽  
English Language ◽  
Operative Time ◽  
Case Series ◽  
Clinical Results ◽  
Learning Curves ◽  
Primary Data ◽  
Qualitative Synthesis ◽  
Half Decade

OBJECTIVE Spine robots have seen increased utilization over the past half decade with the introduction of multiple new systems. Market research expects this expansion to continue over the next half decade at an annual rate of 20%. However, because of the novelty of these devices, there is limited literature on their learning curves and how they should be integrated into residency curricula. With the present review, the authors aimed to address these two points. METHODS A systematic review of the published English-language literature on PubMed, Ovid, Scopus, and Web of Science was conducted to identify studies describing the learning curve in spine robotics. Included articles described clinical results in patients using one of the following endpoints: operative time, screw placement time, fluoroscopy usage, and instrumentation accuracy. Systems examined included the Mazor series, the ExcelsiusGPS, and the TiRobot. Learning curves were reported in a qualitative synthesis, given as the mean improvement in the endpoint per case performed or screw placed where possible. All studies were level IV case series with a high risk of reporting bias. RESULTS Of 1579 unique articles, 97 underwent full-text review and 21 met the inclusion and exclusion criteria; 62 articles were excluded for not presenting primary data for one of the above-described endpoints. Of the 21 articles, 18 noted the presence of a learning curve in spine robots, which ranged from 3 to 30 cases or 15 to 62 screws. Only 12 articles performed regressions of one of the endpoints (most commonly operative time) as a function of screws placed or cases performed. Among these, increasing experience was associated with a 0.24- to 4.6-minute decrease in operative time per case performed. All but one series described the experience of attending surgeons, not residents. CONCLUSIONS Most studies of learning curves with spine robots have found them to be present, with the most common threshold being 20 to 30 cases performed. Unfortunately, all available evidence is level IV data, limited to case series. Given the ability of residency to allow trainees to safely perform these cases under the supervision of experienced senior surgeons, it is argued that a curriculum should be developed for senior-level residents specializing in spine comprising a minimum of 30 performed cases.

Transition to Transradial Access for Mechanical Thrombectomy—Lessons Learned and Comparison to Transfemoral Access in a Single-Center Case Series

2020 ◽  
Author(s):  
Stephan A Munich ◽  
Kunal Vakharia ◽  
Matthew J McPheeters ◽  
Muhammad Waqas ◽  
Michael K Tso ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Case Series ◽  
Access Point ◽  
Lessons Learned ◽  
Access Time ◽  
Access Site ◽  
Access Site Complication ◽  
Transradial Access ◽  
Significant Difference ◽  
Size Constraints

Abstract BACKGROUND Trends in mechanical thrombectomy have emphasized larger bore aspiration catheters that may be difficult to deploy from a radial access point due to size constraints or need to obtain sheathless access. As such, many neurointerventionists are reticent to attempt thrombectomy through transradial access (TRA) for fear of worse outcomes. OBJECTIVE To explore whether mechanical thrombectomy could be achieved safely and effectively through the transradial route. METHODS We retrospectively analyzed the records of patients undergoing mechanical thrombectomy at our academic institute between January 2018 and January 2019, which corresponded to a time when we began to transition to TRA for neurointerventions, including mechanical thrombectomy. We compared the procedural details and clinical outcomes of patients undergoing mechanical thrombectomy using TRA with those using transfemoral access (TFA). RESULTS During the study period, 44 patients underwent mechanical thrombectomy with TRA and 129 with TFA. There was no statistically significant difference in door-to-access time, door-to-reperfusion time, or first-pass recanalization rate. There was no significant difference in modified Rankin Scale (mRS) score at discharge, mRS score at last follow-up, or length of stay. There were 7 access-site complications in the TFA group and none in the TRA group. One patient in the TRA group required crossover to TFA. CONCLUSION Mechanical thrombectomy can be performed safely and effectively from a TRA site without compromising recanalization times or rates. TRA has superior access-site complication profiles compared to TFA.

A Single-Center, Randomized, Controlled Comparison of the Transradial vs Transfemoral Approach for Cerebral Angiography: A Learning Curve Analysis

2019 ◽  
Vol 26 (5) ◽  
pp. 717-724 ◽  
Author(s):  
Yandong Liu ◽  
Xingzhu Wen ◽  
Jun Bai ◽  
Xiangguo Ji ◽  
Kangkang Zhi ◽  
...  
Keyword(s):  
Learning Curve ◽  
Cerebral Angiography ◽  
Fluoroscopy Time ◽  
Procedure Time ◽  
Transfemoral Approach ◽  
Randomized Controlled ◽  
Contrast Volume ◽  
Angiographic Data ◽  
Technical Proficiency ◽  
In The Beginning

Purpose: To compare the characteristics and learning curve of the transfemoral approach (TFA) vs the transradial approach (TRA) for cerebral angiography. Materials and Methods: Between February 2016 and April 2017, 101 patients undergoing cerebral angiography were enrolled. Fifty-one patients (mean age 67 years; 40 men) were randomized to TFA and 50 (mean age 68 years; 41 men) to TRA using a computer-generated random table. The patients’ demographic and angiographic data were recorded and analyzed. The learning curve of a novice interventionist was analyzed for procedure time, puncture time, fluoroscopy time, and contrast volume as markers of technical proficiency with TFA compared with TRA. Median values are given with the interquartile range (IQR). Results: Procedure time [35 (IQR 30, 47.5) vs 31.0 (IQR 25.0, 48.9) minutes, p=0.16), fluoroscopy time [10.3 (IQR 7.6, 13.9) vs 9.4 (IQR 6.1, 17.6) minutes, p=0.70], contrast volume [105 (IQR 92, 120) vs 95.5 (IQR 90, 111.3) mL, p=0.13), radiation exposure [390.2 (IQR 268.2, 617.9) vs 455.8 (IQR 286.8, 602.3) mGy, p=0.74], and the number of catheter exchanges [1 (IQR 1, 3) vs 1 (IQR 1, 1), p=0.06] were not significantly different between the TFA and TRA groups, respectively, but puncture time was shorter with TFA than with TRA [0.6 (IQR 0.5, 1.1) vs 1 (IQR 0.6, 1.9) minutes, p=0.01]. The learning curve was steeper with TRA than with TFA in the beginning stages of training, but with increasing experience, the procedure and fluoroscopy times were better for TRA than for TFA. Training progress was made earlier in TRA. Conclusion: TRA is a reasonable alternative to TFA for cerebral angiography. TRA has a shorter learning curve for novice interventionists.

scholarly journals Measuring Task Learning Curve with Usage Graph Eccentricity Distribution Peaks

2018 ◽  
Vol 9 (3) ◽  
pp. 1
Author(s):  
Vagner Figueredo de Santana ◽  
Rogério Abreu de Paula ◽  
Claudio Santos Pinhanez
Keyword(s):  
Big Data ◽  
Learning Curve ◽  
Large Datasets ◽  
Learning Curves ◽  
Log Analysis ◽  
Task Learning ◽  
Making Sense ◽  
Different Types ◽  
Modeling Task ◽  
Over Time

Interaction logs (or usage data) are abundant in the era of Big Data, but making sense of these data having Human-Computer Interaction (HCI) in mind is becoming a bigger challenge. Interaction Log Analysis involves tackling problems as automatic task identification, modeling task deviation, and computing task learning curve. In this work, we propose a way of measuring task learning curve empirically, based on how task deviations (represented as eccentricity distribution peaks) decrease over time. From the analysis of 427 event-by-event logged sessions (captured under users’ consent) of a technical reference website, this work shows the different types of learning curves obtained through the computation of how deviations decrease over time. The proposed technique supported the identification of 6 different task learning curves in the set of 17 tasks, allowing differentiating tasks easy to perform (e.g., view content and login) from tasks users face more difficulties (e.g., register user and delete content). With such results, HCI specialists can focus on reviewing specific tasks users faced difficulties during real interaction, from large datasets.

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