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Training in Carotid Artery Stenting: Do Carotid Simulation Systems Really Help?

Virtual reality (VR) simulations have long been used for training in aviation and other professions. High-fidelity endovascular procedure simulators are now available, providing procedure simulations with real-time interactions; two-dimensional graphic displays of angiographic anatomy; mechanical interfaces with guidewires, sheaths, and catheters that provide some degree of haptic feedback; modeling of physiologic and pharmacology responses; and other features. Simulators have been incorporated into training programs for physicians learning carotid artery stenting (CAS). For the first time, US Food and Drug Administration approval of a new device (CAS systems) has included a requirement for physician training that incorporates the use of VR simulators. Early experience has shown that simulation is well accepted by trainees, performance on simulators improves with training and practice, and simulation prior to first performing endovascular procedures can improve clinical performance. Specific to CAS, the value of education programs using simulators appears to be tangible as trained but inexperienced CAS operators have clinical results comparable to those of physicians with extensive CAS experience.