Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College, 10th Floor QEQM Building, South Wharf Road, London W2 1NY, UK.
Eur J Vasc Endovasc Surg. 2011 Apr;41(4):492-500. doi: 10.1016/j.ejvs.2010.12.013. Epub 2011 Jan 26.
The ability to perform patient-specific simulated rehearsal of complex endovascular interventions is a technological advance with potential benefits to patient outcomes. This study aimed to evaluate whether patient-specific rehearsal of a carotid artery stenting (CAS) procedure has an influence on tool selection and the use of fluoroscopy.
Following case note and computed tomography (CT) angiographic review of a real patient case, subjects performed the CAS procedure on a virtual reality simulator. Endovascular tool requirements and fluoroscopic angles were evaluated with a pre- and post-case questionnaire. Participants also rated the simulation from 1 (poor) to 5 (excellent).
Thirty-three endovascular physicians with varying degrees of CAS experience were recruited: inexperienced (5-20 CAS procedures) n = 11, moderately (21-50 CAS procedures) n = 7 or highly experienced (>50 CAS procedures) n = 15. For all participants, 96 of a possible 363 changes (26%) were observed from pre- to post-case questionnaires. This was most notable for optimal fluoroscopy C-arm position 15/33 (46%), choice of selective catheter 13/33 (39%), choice of sheath or guiding catheter 11/33 (33%) and balloon dilatation strategy 10/33 (30%). Experience with the CAS procedure did not influence the degree of change significantly (p > 0.05), and all groups exhibited a considerable modification in tool and fluoroscopy preference. The model was considered realistic and useful as a tool to practice a real case (median score 4/5).
Patient-specific simulated rehearsal of a complex endovascular procedure strongly influences tool selection and fluoroscopy preferences for the real case. Further research has to evaluate how this technology may transfer from in vitro to in vivo and if it can reduce the radiation dose and the number of endovascular tools used and improve outcomes for patients in the clinical setting.
对复杂血管内介入治疗进行个体化模拟预演的能力是一种具有潜在效益的技术进步，可以改善患者的预后。本研究旨在评估颈动脉支架置入术（CAS）的个体化模拟预演是否会影响工具选择和透视的使用。
对一个真实患者病例的病历和计算机断层血管造影（CTA）回顾后，参与者在虚拟现实模拟器上进行了 CAS 手术。通过术前和术后问卷评估血管内工具需求和透视角度。参与者还对模拟从 1（差）到 5（优）进行了评分。
共招募了 33 名具有不同 CAS 经验程度的血管内医生：无经验（5-20 例 CAS 手术）11 名，中度经验（21-50 例 CAS 手术）7 名或高度经验（>50 例 CAS 手术）15 名。对于所有参与者，从术前到术后问卷共观察到 363 次变化中的 96 次（26%）。最明显的变化是优化透视 C 臂位置（33%）、选择选择性导管（39%）、选择鞘管或引导导管（33%）和球囊扩张策略（30%）。CAS 手术经验程度对变化程度没有显著影响（p > 0.05），所有组都对工具和透视偏好进行了相当大的调整。该模型被认为是现实和有用的，可作为练习真实病例的工具（中位数评分为 4/5）。
复杂血管内手术的个体化模拟预演强烈影响真实病例的工具选择和透视偏好。需要进一步研究该技术如何从体外转移到体内，以及它是否可以减少辐射剂量和血管内工具的使用数量，并改善临床环境中患者的预后。
