Document Detail


Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal.
MedLine Citation:
PMID:  22743018     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Carotid artery stenting (CAS) is a technically demanding procedure with a risk of periprocedural stroke. A scoring system based on anatomic criteria has been developed to facilitate patient selection for CAS. Advancements in simulation science also enable case evaluation through patient-specific virtual reality (VR) rehearsal on an endovascular simulator. This study aimed to validate the anatomic scoring system for CAS using the patient-specific VR technology. METHODS: Three patients were selected and graded according to the CAS scoring system (maximum score, 9): one easy (score, <4.9), one intermediate (score, 5.0-5.9), and one difficult (score, >7.0). The three cases were performed on the simulator in random order by 20 novice interventionalists pretrained in CAS. Technical performances were assessed using simulator-based metrics and expert-based ratings. RESULTS: The interventionalists took significantly longer to perform the difficult CAS case (median 31.6 vs 19.7 vs 14.6 minutes; P < .0001) compared with the intermediate and easy case; similarly, more fluoroscopy time (20.7 vs 12.1 vs 8.2 minutes; P < .0001), contrast volume (56.5 vs 51.5 vs 50.0 mL; P = .0060), and roadmaps (10 vs 9 vs 9; P = .0040) were used. The quality of performance declined significantly as the cases became more challenging (score 24 vs 22 vs 19; P < .0001). CONCLUSIONS: The anatomic scoring system for CAS can predict the difficulty of a CAS procedure as measured by patient-specific VR. This scoring system, with or without the additional use of patient-specific VR, can guide novice interventionalists in selecting appropriate patients for CAS. This may reduce the perioperative stroke risk and enhance patient safety.
Authors:
Willem I M Willaert; Nicholas J Cheshire; Rajesh Aggarwal; Isabelle Van Herzeele; Gerard Stansby; Sumaira Macdonald; Frank E Vermassen;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-26
Journal Detail:
Title:  Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter     Volume:  -     ISSN:  1097-6809     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, United Kingdom; Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
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