Abstract 3830: Metric-Based Virtual Reality Simulation Detects Performance Differences in Carotid Angiography Using a Complex Catheter versus a Simple Catheter
Background: Metric-based virtual reality (VR) simulation is a novel teaching mechanism for endovascular procedures. Carotid angiography (CA) ex-vivo training is preferable given the risk of stroke associated with carotid artery catheterization. Complex aortic arch anatomy may require non-standard catheters (i.e. Simmons) that are unfamiliar and more difficult to use. We sought to determine whether the Vascular Interventional System Trainer (VIST) simulator could detect a difference in a participant’s performance of CA using both the Simmons catheter (SC) and the Right Judkins catheter (RJC).
Methods: 19 experienced endovascular physicians with limited CA experience participated in the Emory NeuroAnatomy Carotid Training Course and had 1.5 days of CA didactics. Then, participants performed 1 mentored and supervised simulated CA. Next, supervised, but un-mentored, cases were performed first with the RJC then with the SC. The VIST recorded static (procedure and fluoroscopy times and contrast volume) and dynamic (catheter vessel errors [CVE], catheter movement errors [CME], and catheter lesion errors [CLE]) metrics. Total catheter errors (TCE) were defined as the sum of CVE, CME, and CLE.
Results: Compared to the RJC, procedure (1136±285 vs. 952±259 sec) and fluoroscopy (778±259 vs. 530±172 sec) times were significantly longer, while CVE (23±36 vs. 11±10) and TCE (33±45 vs. 18±17) were significantly higher with the SC. Although the number of CLE and CME committed using the SC were higher, these differences were not significant (see table⇓).
Conclusions: The VIST simulator was able to detect significant differences in dynamic metric errors (CVE and TCE) when comparing the use of a complex (SC) to a simpler catheter (RJC) during CA. Static metrics of performance such as procedure time and fluoroscopy time were significantly greater using the SC compared to the RJC. In the same operators, the VIST simulator can detect differences in metrics between catheters.