Patient-specific simulation in carotid artery stenting.
OBJECTIVE
Patient-specific virtual reality (VR) simulation is a technologic advancement that allows planning and practice of the carotid artery stenting (CAS) procedure before it is performed on the patient. The initial findings are reported, using this novel VR technique as a tool to optimize technical and nontechnical aspects of this complex endovascular procedure.


METHODS
In the angiography suite, the same interventional team performed the VR rehearsal and the actual CAS on the patient. All proceedings were recorded to allow for video analysis of team, technical, and nontechnical skills.


RESULTS
Analysis of both procedures showed identical use of endovascular tools, similar access strategy, and a high degree of similarity between the angiography images. The total procedure time (24.04 vs 60.44 minutes), fluoroscopy time (11.19 vs 21.04 minutes), and cannulation of the common carotid artery (1.35 vs 9.34) took considerably longer in reality. An extensive questionnaire revealed that all team members found that the rehearsal increased the subjective sense of teamwork (4/5), communication (4/5), and patient safety (4/5).


CONCLUSIONS
A VR procedure rehearsal is a practical and feasible preparatory tool for CAS and shows a high correlation with the real procedure. It has the potential to enhance the technical, nontechnical, and team performance. Further research is needed to evaluate if this technology can lead to improved outcomes for patients.
Willaert
Willem
W
Department of Biosurgery and Surgical Technology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. wimwillaert@hotmail.com
Aggarwal
Rajesh
R
Bicknell
Colin
C
Hamady
Mo
M
Darzi
Ara
A
Vermassen
Frank
F
Cheshire
Nicholas
N
D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003198:Computer Simulation; D057510:Endovascular Procedures / Q000193:education*; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D015641:Radiography, Interventional; D015607:Stents; D014584:User-Computer Interface