title: Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal.
abstract: 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 cases; 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: Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, United Kingdom. wimwillaert@hotmail.com
authors: Willem I M
authors: WI
authors: Willaert
authors: Nicholas J
authors: NJ
authors: Cheshire
authors: Rajesh
authors: R
authors: Aggarwal
authors: Isabelle
authors: I
authors: Van Herzeele
authors: Gerard
authors: G
authors: Stansby
authors: Sumaira
authors: S
authors: Macdonald
authors: Frank E
authors: FE
authors: Vermassen
mesh_terms: D000328:Adult; D002340:Carotid Artery Diseases / Q000601:surgery*; D002983:Clinical Competence; D003198:Computer Simulation; D057510:Endovascular Procedures / Q000193:education*; D006305:Health Status Indicators; D006801:Humans; D008955:Models, Cardiovascular; D018579:Patient Selection; D018794:Problem-Based Learning; D015203:Reproducibility of Results; D015607:Stents