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  • Simulator-Based angiography and endovascular neurosurgery curriculum: A longitudinal evaluation of performance following simulator based diagnostic angiography and endovascular neurosurgery training.

    Final Number:

    Jeffrey Scott Pannell MD; David Oveisi BA; David Santiago-Dieppa BS; Harrison Wang MD; Jon Hallstrom MD; Alexander Arash Khalessi MD, MS

    Study Design:

    Subject Category:

    Meeting: AANS/CNS Cerebrovascular Section 2014 Annual Meeting

    Introduction: This study establishes performance metrics for angiography and neuroendovascular surgery procedures based on longitudinal improvement in individual trainees with differing levels of training and experience.

    Methods: Over the course of 30 days, five trainees performed ten diagnostic angiograms, coiled ten carotid terminus aneurysms in the setting of subarachnoid hemorrhage, and performed ten left middle cerebral artery embolectomies on a Simbionix Angio Mentor simulator. All procedures were nonconsecutive. Total procedure time, fluoroscopy time, contrast dose, heart rate, blood pressures, medications administered, packing densities, number of coils used, and number of stent-retriever passes were recorded. Image quality was rated, and the absolute value of technically unsafe events was recorded. The trainees’ device selection, macrovascular access, microvascular access, clinical management, and overall performance of the trainee was rated during each procedure based on a traditional Likert scale score of 1=fail, 2=poor, 3=satisfactory, 4=good, and 5=excellent.

    Results: After performing five diagnostic angiograms and five embolectomies, all subjects demonstrated marked decreases in procedure time, fluoroscopy doses, contrast doses, and adverse technical events as well as marked improvements in image quality, device selection, access scores, and overall technical performance (p<0.05). Similarly, trainees demonstrated marked improvement technical performance and clinical management after five coiling procedures (p<0.05). However, trainees with less prior experience deploying coils continued to experience intra-procedural ruptures up to the 8th embolization which occurred due to exertion of greater force than appropriate for coil placement.

    Conclusions: Trainees across all levels of training and prior experience demonstrated a significant performance improvement after completion of our simulator curriculum consisting of five diagnostic angiograms, five embolectomy cases, and ten aneurysm coil embolizations.

    Patient Care: This study establishes a formal simulator curriculum and associated performance metrics for trainees performing simulated angiograms and endovascular neurosurgery procedures prior to participation in clinical angiography and endovascular neurosurgery procedures.

    Learning Objectives: By the conclusion of this session, participants should: 1. Understand the challenges facing trainees attempting to develop endovascular neurosurgical proficiency. 2. Understand the importance of quantification of performance metrics in simulated procedures in training the endovascular neurosurgeons of the future. 3. Understand the impact of a standardized simulator curriculum on the performance of endovascular neurosurgerical trainees.


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