Clinical competence statement on carotid stenting: Training and credentialing for carotid stenting?Multispecialty consensus recommendations

STENTINGThe emergence of carotid stent placement as an accepted alternative to high-surgical-risk carotid endarterectomy has been facilitated by device innovation, refinements of technique, and careful patient selection.Carotid revascularization involves interventional skills, equipment, and clinical management skills that differ significantly from those employed in other vascular distributions.Moreover, it involves treatment of a uniquely sensitive organ system, wherein minor errors or complications can have catastrophic effects.Given the high-risk nature of carotid revascularization and the availability of alternative treatment modalities, decisions regarding optimal therapy require a comprehensive knowledge base of the disease and its ramifications in order to properly assess the risk-benefit ratio of each therapeutic option.Published results demonstrate improved patient outcomes with increasing operator experience, thereby confirming a learning curve for this procedure [1][2][3][4][5].This, in addition to the unique aspects of the disease process and end organ, underscores the need for careful and thorough training and preparation.Medical specialists from several different disciplines, each of which emphasizes a particular set of skills, expertise, and approach, are involved in the management of carotid disease and will be performing carotid stent procedures.This statement is intended to delineate the core elements that are required to achieve competence in carotid stenting, regardless of specialty, in order to maintain high-quality outcomes.