The use of virtual reality for carotid artery stenting (CAS) training in type I and type III aortic arches

AIM: Simulation has been proposed to improve learning curves in carotid artery stenting (CAS), but previous studies have only evaluated CAS simulation in a single type of arch usually either type I or type II. The aim of our study is to define the use of virtual reality for CAS training in type I and type III aortic arches for novice operators. MATERIALS AND METHODS: Fifty experienced interventionalists and fifty novice trainees with no prior experience with endovascular procedures performed a virtual CAS in a type I aortic arch case and one in a type III arch case. They trained on simulator for two hours and then repeated the procedures. Data of the procedures were collected and analysed. RESULTS: Among novice operators, 38 out of 50 ended the first procedure on type I arch (76%) and 32% (16 out of 50) concluded the first procedure on type III arch (p < .05). After training, 100% of novice ended the easy case and 56% (28 out of 50) concluded the difficult case (p < .05). All experienced operators successfully carried out the simulations. The simulator induced greater improvement among novice in type I arch rather than in type III arch. Performances of experienced didn’t improve significantly. Among novice, virtual performances of “difficult” cases were significantly worse than those of “easy” cases, both before and after training. CONCLUSIONS: Simulator is an effective tool for training of novice operators in type I aortic arch; on the contrary its role has yet to be established in type III aortic arch.