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Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal

Lookup NU author(s): Professor Gerard Stansby, Dr Sumaira MacDonald


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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. (J Vasc Surg 2012;56:1763-70.)

Publication metadata

Author(s): Willaert WIM, Cheshire NJ, Aggarwal R, Van Herzeele I, Stansby G, Macdonald S, Vermassen FE, European Virtual Reality Endovascular Research Team (EVERest)

Publication type: Article

Publication status: Published

Journal: Journal of Vascular Surgery

Year: 2012

Volume: 56

Issue: 6

Pages: 1763-1770

Print publication date: 27/06/2012

ISSN (print): 0741-5214

ISSN (electronic): 1097-6809

Publisher: Mosby Inc.


DOI: 10.1016/j.jvs.2012.03.257


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