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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

(2012) JOURNAL OF VASCULAR SURGERY. 56(6). p.1763-1770
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Abstract
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.
Keywords
EVENTS, CAS, OUTCOMES, RISK, PREDICTORS

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MLA
Willaert, Willem, Nicholas J Cheshire, Rajesh Aggarwal, et al. “Improving Results for Carotid Artery Stenting by Validation of the Anatomic Scoring System for Carotid Artery Stenting with Patient-specific Simulated Rehearsal.” JOURNAL OF VASCULAR SURGERY 56.6 (2012): 1763–1770. Print.
APA
Willaert, Willem, Cheshire, N. J., Aggarwal, R., Van Herzeele, I., Stansby, G., Macdonald, S., & Vermassen, F. (2012). Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal. JOURNAL OF VASCULAR SURGERY, 56(6), 1763–1770.
Chicago author-date
Willaert, Willem, Nicholas J Cheshire, Rajesh Aggarwal, Isabelle Van Herzeele, Gerard Stansby, Sumaira Macdonald, and Frank Vermassen. 2012. “Improving Results for Carotid Artery Stenting by Validation of the Anatomic Scoring System for Carotid Artery Stenting with Patient-specific Simulated Rehearsal.” Journal of Vascular Surgery 56 (6): 1763–1770.
Chicago author-date (all authors)
Willaert, Willem, Nicholas J Cheshire, Rajesh Aggarwal, Isabelle Van Herzeele, Gerard Stansby, Sumaira Macdonald, and Frank Vermassen. 2012. “Improving Results for Carotid Artery Stenting by Validation of the Anatomic Scoring System for Carotid Artery Stenting with Patient-specific Simulated Rehearsal.” Journal of Vascular Surgery 56 (6): 1763–1770.
Vancouver
1.
Willaert W, Cheshire NJ, Aggarwal R, Van Herzeele I, Stansby G, Macdonald S, et al. Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal. JOURNAL OF VASCULAR SURGERY. 2012;56(6):1763–70.
IEEE
[1]
W. Willaert et al., “Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal,” JOURNAL OF VASCULAR SURGERY, vol. 56, no. 6, pp. 1763–1770, 2012.
@article{5735009,
  abstract     = {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.},
  author       = {Willaert, Willem and Cheshire, Nicholas J and Aggarwal, Rajesh and Van Herzeele, Isabelle and Stansby, Gerard and Macdonald, Sumaira and Vermassen, Frank},
  issn         = {0741-5214},
  journal      = {JOURNAL OF VASCULAR SURGERY},
  keywords     = {EVENTS,CAS,OUTCOMES,RISK,PREDICTORS},
  language     = {eng},
  number       = {6},
  pages        = {1763--1770},
  title        = {Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal},
  url          = {http://dx.doi.org/10.1016/j.jvs.2012.03.257},
  volume       = {56},
  year         = {2012},
}

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