• Willem I M Willaert, Nicholas J Cheshire, Rajesh Aggarwal, Isabelle Van Herzeele, Gerard Stansby, Sumaira Macdonald, Frank E Vermassen, and European Virtual Reality Endovascular Research Team (EVERest).
• Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, United Kingdom. wimwillaert@hotmail.com
• J. Vasc. Surg. 2012 Dec 1;56(6):1763-70.

ObjectiveCarotid 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.MethodsThree 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.ResultsThe 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).ConclusionsThe 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.Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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