Development and Validation of a Novel Stenosis Model for Percutaneous Transluminal Angioplasty Training of the Internal Carotid Artery

TL;DR

This paper introduces a new 3D-printed model for training in a medical procedure to treat artery narrowing in the neck, showing it works well for realistic practice.

Contribution

A novel 3D-printed stenosis model for PTA training in the internal carotid artery is developed and validated.

Findings

Experienced participants performed the procedure faster and with lower radiation doses.

The model was rated as realistic and feasible for training purposes.

No significant difference in contrast volume used was found between experience groups.

Abstract

The rising demand for endovascular stroke therapy highlights the need for standardized training environments. Studies have shown the positive impact of simulator-based training for neurointerventional procedures. Given the frequent use of percutaneous transluminal angioplasty (PTA) of the internal carotid artery (ICA) in acute settings, specialized simulation training is crucial. This study evaluates the feasibility of a custom-made ICA stenosis model for PTA simulation.

Internally developed 3D-printed circular clamps were attached to patient-based 3D printed ICA models and integrated into a previously described realistic whole-body neurovascular simulation model HANNES (Hamburg Anatomic Neurointerventional Endovascular Simulator) to simulate a proximal ICA stenosis. Participants (N = 5) of varying experience levels each performed three PTA procedures. Fluoroscopy time, radiation doses, and the extent of stenosis and balloon inflation pressure were assessed. After simulation, participants rated the model in terms of haptic, feasibility and applicability.

For statistical analysis, the participants were divided into two groups according to their experience level. There was a statistically significant difference in the procedure duration between both groups, U = 10.500, Z = −1.968, p < 0.05. Significant test results could also be demonstrated for radiation doses (DAP) among groups, Kolmogorov-Smirnov p < 0.05, U = 7.000, Z = −2.357, p < 0.05. No difference was shown between the total contrast volume (ml) among groups that was used during procedures (m = 11.67, SD 2.09).

The authors propose a novel ICA stenosis simulation model for training of the cervical PTA. The model provides a realistic and replicable method for standardized procedural training.

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