Emory Report
February 7, 2005
Volume 61, Number 18


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February 7, 2005
Cates urges virtual-reality training for carotid stenting

BY sherry baker

Last fall, the U.S. Food and Drug Administration (FDA) announced approval of carotid stenting, a technique for treating potentially life-threatening blockages in the arteries of the neck that lead to the brain.

Just as stents (tiny mesh tubes) often are used following coronary angioplasty to keep arteries open, they also can be used to prop open carotid arteries in the neck and are rapidly being incorporated into interventional cardiology, vascular surgery, interventional radiology and vascular medicine practices. But how can physicians in these specialties—who might have very little experience with stenting—best learn to perform this potentially risky procedure?

A committee of nationally recognized cardiovascular leaders, including Emory Heart Center cardiologist Christopher Cates, has published a clinical competence statement simultaneously in the current issues of several respected medical journals, including the Journal of the American College of Cardiology (JACC), that specifically answers that question.

The consensus statement, prepared by the Society for Cardiovascular Angiography and Interventions, the Society for Vascular Medicine and Biology, and the Society for Vascular Surgery, sets a consistent standard for physician training and credentialing. It calls for physicians to be fully credentialed to perform peripheral interventions and to actively perform endovascular procedures before undertaking focused carotid-stent training. The statement also makes clear that carotid-stenting placement should be limited to institutions that can offer independent neurological assessment and can ensure that optimal outcomes are being achieved and reported so that patient safety is protected.

“In addition, the consensus statement says virtual reality (VR) training should be incorporated into carotid stenting training,” said Cates, director of vascular intervention at Emory and Crawford Long hospitals. “This is based on mounting evidence that VR training is a better, faster and safer way for physicians to learn endovascular procedures than the traditional training route.”

Cates pointed out that, unlike surgery, carotid stenting makes the physician’s job more difficult because tissues are not seen or felt directly.

“Learning the hand-eye coordination of instruments, catheters and guide wires is very complex,” he said. “The clinical competence statement recognizes that VR can play an important role in helping physicians develop the required new skills for carotid stent placement. Doctors are able to learn how to perform carotid stenting on a VR simulator, working in lifelike settings, until they are proficient.”

Using simulators resembling human mannequins, physicians thread a catheter through an artificial circulatory system and view the “patient’s” angiograms, instead of practicing on people. Emory already has trained more than 130 physicians in carotid angiography using this VR technique.

Carotid artery disease, a buildup of atherosclerotic plaque (fatty material) in major vessels of the neck that supply blood to the brain, is a risk factor for stroke, the nation’s third-leading cause of death and a major cause of serious, long-term disability. According to the American Stroke Association, someone in the United States has a stroke every 45 seconds; about 700,000 Americans suffer from stroke each year.