Wooster Mathew, Doyle Adam, Hislop Sean, Glocker Roan, Armstrong Paul, Singh Michael, Illig Karl A
1 Medical University of South Carolina, Department of Surgery, Division of Vascular Surgery, Charleston, SC, USA.
2 Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Vasc Endovascular Surg. 2018 Apr;52(3):169-172. doi: 10.1177/1538574417753005. Epub 2018 Jan 11.
To determine whether rehearsal using patient-specific information loaded onto an endovascular simulator prior to carotid stenting improves procedural efficiency and outcomes.
Patients scheduled for carotid artery stenting who had adequate preoperative computed tomography (CT) imaging were considered for enrollment. After obtaining informed consent, patients were randomized to control versus rehearsal groups. Those in the rehearsal group had their CT scans loaded into an endovascular simulator (Angio Mentor) followed by case rehearsal by the attending on the simulator within 24 hours prior to the procedure; control patients underwent routine carotid stenting without rehearsal. Contrast usage, fluoroscopy time, and timing of procedural steps were recorded by a blinded observer during the actual case to determine benefit.
Fifteen patients were enrolled, with 6 patients randomized to the rehearsal group and 9 to the control. All measures showed improvement in the rehearsal group: Mean contrast volume (59.2 vs 76.9 mL), fluoroscopy time (11.4 vs 19.4 minutes), overall operative time (31.9 vs 42.5 minutes), time to common carotid sheath placement (17.0 vs 23.3 minutes), and total carotid sheath dwell time (14.9 vs 19.2 minutes) were all lower (more favorable) in the rehearsal group. The study was terminated early due to the lack of simulator access, and all P values were thus greater than .05 due to the lack of power. No strokes or other adverse events occurred in either group.
Case-specific simulator rehearsal using patient-specific imaging prior to carotid stenting is associated with numerically less contrast usage, operative time, and radiation exposure, although this study was underpowered.
确定在颈动脉支架置入术前使用加载到血管内模拟器上的患者特定信息进行预演是否能提高手术效率和改善手术结果。
计划进行颈动脉支架置入术且术前计算机断层扫描（CT）成像充分的患者被纳入研究。获得知情同意后，患者被随机分为对照组和预演组。预演组患者的CT扫描图像被加载到血管内模拟器（Angio Mentor）中，然后在手术前24小时内由主治医生在模拟器上进行病例预演；对照组患者进行常规颈动脉支架置入术，不进行预演。在实际手术过程中，由一名不知情的观察者记录造影剂使用量、透视时间和手术步骤的时间，以确定预演的益处。
共纳入15例患者，其中6例随机分配到预演组，9例分配到对照组。所有指标在预演组均有改善：预演组的平均造影剂用量（59.2 vs 76.9 mL）、透视时间（11.4 vs 19.4分钟）、总手术时间（31.9 vs 42.5分钟）、颈总动脉鞘置入时间（17.0 vs 23.3分钟）和颈总动脉鞘总留置时间（14.9 vs 19.2分钟）均更低（更有利）。由于缺乏模拟器，该研究提前终止，因此由于检验效能不足，所有P值均大于0.05。两组均未发生中风或其他不良事件。
尽管本研究检验效能不足，但在颈动脉支架置入术前使用患者特定成像进行病例特定模拟器预演在数值上与较少的造影剂使用量、手术时间和辐射暴露相关。
