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. 2023 Sep 4:14:1247421.
doi: 10.3389/fneur.2023.1247421. eCollection 2023.

Evaluation of intracranial stenting in a simulated training and assessment environment for neuroendovascular procedures

Anna A Kyselyova  1 , Andreas M Frölich  1 , Maxim Bester  1 , Caspar Brekenfeld  1 , Jan-Hendrik Buhk  1   2 , Andreas Ding  3 , Frank Nagl  3 , Tobias J Jost  3 , Helena Guerreiro  1 , Ngoc Tuan Ngo  1 , Jens Fiehler  1 , Fabian Flottmann  1
Affiliations

Evaluation of intracranial stenting in a simulated training and assessment environment for neuroendovascular procedures

Anna A Kyselyova et al. Front Neurol. .

Abstract

Purpose: Given the inherent complexity of neurointerventional procedures and the associated risks of ionizing radiation exposure, it is crucial to prioritize ongoing training and improve safety protocols. The aim of this study is to assess a training and evaluation in-vitro environment using a vascular model of M1 stenosis, within a clinical angiography suite, without relying on animal models or X-ray radiation.

Materials and methods: Using a transparent model replicating M1 stenosis, we conducted intracranial stenting procedures with four different setups (Gateway & Wingspan, Gateway & Enterprise, Neurospeed & Acclino, and Pharos Vitesse). A video camera was integrated with the angiography system's monitor for real-time visualization, while a foot switch was employed to simulate live fluoroscopy. Three neuroradiologists with varying levels of expertise performed each procedure for three times. The total duration of fluoroscopy as well as the time from passing the stenosis with the wire to completion of the procedure were recorded using a dedicated software designed for this experimental setup.

Results: Compared to the Gateway & Wingspan procedure, the total fluoroscopy time reduced significantly with the Gateway & Enterprise, Neurospeed & Acclino, and Pharos Vitesse procedures by 51.56 s, 111.33 s, and 144.89 s, respectively (p < 0.001). Additionally, physicians with under 2 years and over 5 years of experience reduced FT by 62.83 s and 106.42 s, respectively, (p < 0.001), compared to a novice physician. Similar trends were noted for the time of wire distal to stenosis, with significant reductions for Neurospeed & Acclino and Pharos Vitesse compared to both Gateway & Wingspan as well as Gateway & Enterprise (all p < 0.001).

Conclusion: Procedures requiring wire exchange maneuvers exhibited nearly twice the fluoroscopy time in comparison to balloon-mounted stenting or stent-placement via PTA balloon catheters. The more experienced neuroradiologist demonstrated significantly quicker performance in line with expectations in a real-life clinical setting, when compared to the less experienced interventionalist. This in-vitro setup allowed the evaluation of alternative technical approaches and differences in experience of operators without the use of animal models or X-ray. The setup combines advantages of simulators and silicone vessel models in a realistic working environment.

Keywords: flow model; intracranial stenting; simulation; stenosis; stroke.

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Conflict of interest statement

J-HB received personal fees from Consultant for Microvention, Stryker, Cerenovus, Acandis, and Medtronic outside the submitted work. JF received personal fees from Consultant for Microvention, Stryker, Cerenovus, Acandis, Penumbra, and Medtronic outside the submitted work. He is a member of the Executive Board of the scientific societies DGNR and ESMINT. AD, FN, and TJ were employed by Acandis, Acandis GmbH & Co. KG. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Interventional neuroradiological Angio Suite Allura Clarity FD 20 (Philips Healthcare) with the training system set up (arrow shows the camera recording of the vessel model).
Figure 2
Figure 2
The average fluoroscopy time (first bar) and average wire distal to stenosis time (second bar) for various techniques. The values are measured in seconds (s).
See this image and copyright information in PMC

References

    1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. (2017) 135:e146–603. doi: 10.1161/CIR.0000000000000485, PMID: - DOI - PMC - PubMed
    1. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. (2015) 372:2296–306. doi: 10.1056/NEJMoa1503780, PMID: - DOI - PubMed
    1. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. (2015) 372:2285–95. doi: 10.1056/NEJMoa1415061, PMID: - DOI - PubMed
    1. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. (2015) 372:1019–30. doi: 10.1056/NEJMoa1414905, PMID: - DOI - PubMed
    1. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. (2018) 378:11–21. doi: 10.1056/NEJMoa1706442, PMID: - DOI - PubMed

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