Virtual reality simulation objectively differentiates level of carotid stent experience in experienced interventionalists.

Abstract

Technical proficiency in carotid artery stent (CAS) procedures is paramount to ensure patient safety. If virtual reality (VR) simulation is to be used as a valid means for credentialing physicians for CAS procedures, the assessment parameters must be able to evaluate the performance during CAS and to differentiate level of CAS experience. The aim of this study was to validate assessment parameters of a commercially available VR simulator (VIST, Vascular Interventional Surgical Trainer, Mentice, Gothenburg, Sweden) during a CAS procedure in experienced interventionalists. Forty-five interventionalists (cardiologists, radiologists, vascular surgeons) who had performed at least 100 endovascular therapeutic cases, with varying experience in CAS were recruited: groups A, n = 12 (0 CAS procedures), B, n = 12 (1 to 20 CAS), C, n = 10 (21 to 50 CAS) and D, n = 11 (>50 CAS). All subjects performed a standard CAS procedure with a type I arch and were assessed by quantitative (procedure time, amount of contrast given, number of cineloops recorded, fluoroscopic time) and qualitative (clinical parameters and errors) metrics of the simulator. Participants also rated the realism and training potential of the simulator on a scale from 1 (poor) to 5 (excellent). There were significant differences across the four groups A to D for procedure time (medians 20.5 vs 24 vs 19 vs 16 minutes, P = .002) and fluoroscopic time (12.5 vs 13 vs 10 vs 7 minutes, P < .001), respectively. Total numbers of errors recorded by the VR simulator did not achieve statistical significance (P = .209) across the four groups. All subjects rated the simulator highly (median 4) in terms of realism and training potential. Total time and fluoroscopic time both recorded by a realistic VR simulator differentiate between levels of CAS experience in experienced interventionalists. Error scoring is currently not a valid mode of assessment and needs refinement.