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  • Training Matters
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Virtual reality training for carotid intervention

Nature Clinical Practice Neurology volume 3, pages 470–471 (2007)Cite this article

Virtual reality (VR) simulations have a growing role in teaching physicians how to perform high-risk, complex, or technically demanding procedures, such as endoscopy, videoendoscopic surgery, cardiac catheterization and interventions, and other procedures that include imaging guidance. Simulators for cerebrovascular angiography and carotid artery stenting (CAS) are particularly relevant to the training of neurologists.

Currently available high-fidelity VR simulators enable real-time replication of cerebrovascular procedures. The simulators use computer-graphic reconstructions of angiographic anatomy (see Supplementary Movie 1,2,3,4,5,6 online for examples). They have mechanical interfaces with guide wires, sheaths and catheters that provide some degree of haptic feedback, and are able to model both normal and abnormal physiological and pharmacological responses.

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References

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Author notes

  1. University of California, Davis, Vascular Center, 4680 Y Street, Suite 3400, Sacramento, CA 95817, USA david.dawson@ucdmc.ucdavis.edu

Authors and Affiliations

  1. DL Dawson is Professor of Clinical Surgery at the University of California, Davis, Sacramento, CA, USA.,

    David L Dawson

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  1. David L Dawson
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Competing interests

The author has declared associations with Medical Simulation Corporation (one-time panel participation, with the proceedings to be published in Endovascular Today; he received travel support and a US$1,000 honorarium).

Supplementary information

Supplementary Movie 1

Simulation offers a means not only to practice normal carotid artery stenting procedural steps, but also to expose the learner to specific complications and their management. In the first example case, the internal carotid artery has a flow limiting dissection immediately distal to the stent. Imaging in multiple views may help define the anatomy. Video Clip 1 shows a simulated AP carotid arteriogram. There is lucency at the site of the dissection, with slow flow in the internal carotid artery distal to the lesion. Subintimal contrast staining remains after the luminal contrast column is gone. (MPG 181 kb)

Supplementary Movie 2

Video Clip 2 shows the same dissection in a lateral projection, again with slow flow in the carotid artery. The embolic protection device (EPD) on the 0.014” guidewire is seen positioned in the petrous (C2) segment of the internal carotid artery. (MPG 77 kb)

Supplementary Movie 3

The dissection flap is managed with the placement of a distal overlapping self-expanding stent. Flow after stent placement is normal, with no residual stenosis (see Video Clip 3). (MPG 81 kb)

Supplementary Movie 4

The second example case provides an example of arterial spasm after stent placement. In Video Clip 4, the post-stent angiogram shows multiple areas of focal, smooth narrowing in the internal carotid artery, with almost no flow beyond the EPD. (MPG 98 kb)

Supplementary Movie 5

After intra-arterial administration of nitroglycerin, a vasodilator, there is partial resolution of the arterial vasospasm with improvement in flow, as shown in Video Clip 5. (MPG 144 kb)

Supplementary Movie 6

Video Clip 6 shows removal of the EPD and administration of additional nitroglycerine, resulting in further resolution of the arterial spasm. A satisfactory outcome is demonstrated in the completion angiogram. (MPG 81 kb)

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Dawson, D. Virtual reality training for carotid intervention. Nat Rev Neurol 3, 470–471 (2007). https://doi.org/10.1038/ncpneuro0578

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