title: Role of patient-specific virtual reality rehearsal in carotid artery stenting.
abstract: BACKGROUND
  Recent advances in simulation science permit patient-specific rehearsal of endovascular stenting procedures. This study aimed to evaluate how effectively real interventions are replicated by patient-specific rehearsal technology, and to assess its value as a preparatory tool for the interventionalist and the operating team.
  
  
  METHODS
  All patients deemed candidates for carotid artery stenting procedures with suitable computed tomography images were enrolled. Each team member rehearsed the virtual procedure in the laboratory, simulated operating theatre or angiography suite environment immediately before treating the real patient. Dexterity and qualitative metrics were recorded. Subjective questionnaires used a Likert scale from 1 (poor) to 5 (excellent).
  
  
  RESULTS
  Of 18 patients, three were excluded. In 11 of 15 and 13 of 15 patients respectively endovascular tool use and fluoroscopy angles were identical during rehearsal and the real procedure. In a third of patients, the simulator did not adequately predict difficulties in cannulating the stenotic internal or common carotid arteries. The procedure realism, value in evaluating the case, increase in efficiency in tool use, and potential to increase communication, confidence and team performance were all rated highly (4 of 5).
  
  
  CONCLUSIONS
  Patient-specific rehearsal was rated highly for both face and content validity. Access strategy, endovascular material use and angiographic imaging were all replicated effectively, although certain biomechanical vessel properties seemed to be replicated to a lesser degree. Patient-specific rehearsal constitutes a unique tool that may help tailor endovascular material choice, and optimize the preoperative preparation of the interventionalist and team.
authors.affiliation: Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. wimwillaert@hotmail.com
authors.forename: W I M
authors.initials: WI
authors.lastname: Willaert
authors.forename: R
authors.initials: R
authors.lastname: Aggarwal
authors.forename: I
authors.initials: I
authors.lastname: Van Herzeele
authors.forename: M
authors.initials: M
authors.lastname: Plessers
authors.forename: N
authors.initials: N
authors.lastname: Stroobant
authors.forename: D
authors.initials: D
authors.lastname: Nestel
authors.forename: N
authors.initials: N
authors.lastname: Cheshire
authors.forename: F
authors.initials: F
authors.lastname: Vermassen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017536:Carotid Artery, Common / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards; D003198:Computer Simulation; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010348:Patient Care Team / Q000592:standards; D010358:Patient Participation; D011214:Practice, Psychological; D011597:Psychomotor Performance; D015607:Stents; D011795:Surveys and Questionnaires; D014584:User-Computer Interface