Feasibility of a customizable training environment for neurointerventional skills assessment.

To meet increasing demands to train neuroendovascular techniques, we developed a dedicated simulator applying individualized three-dimensional intracranial aneurysm models ('HANNES'; Hamburg Anatomic Neurointerventional Endovascular Simulator). We hypothesized that HANNES provides a realistic and reproducible training environment to practice coil embolization and to exemplify disparities between neurointerventionalists, thus objectively benchmarking operators at different levels of experience. Six physicians with different degrees of neurointerventional procedural experience were recruited into a standardized training protocol comprising catheterization of two internal carotid artery (ICA) aneurysms and one basilar tip aneurysm, followed by introduction of one framing coil into each aneurysm and finally complete coil embolization of one determined ICA aneurysm. The level of difficulty increased with every aneurysm. Fluoroscopy was recorded and assessed for procedural characteristics and adverse events. Physicians were divided into inexperienced and experienced operators, depending on their experience with microcatheter handling. Mean overall catheterization times increased with difficulty of the aneurysm model. Inexperienced operators showed longer catheterization times (median; IQR: 47; 30-84s) than experienced operators (21; 13-58s, p = 0.011) and became significantly faster during the course of the attempts (rho = -0.493, p = 0.009) than the experienced physicians (rho = -0.318, p = 0.106). Number of dangerous maneuvers throughout all attempts was significantly higher for inexperienced operators (median; IQR: 1.0; 0.0-1.5) as compared to experienced operators (0.0; 0.0-1.0, p = 0.014). HANNES represents a modular neurointerventional training environment for practicing aneurysm coil embolization in vitro. Objective procedural metrics correlate with operator experience, suggesting that the system could be useful for assessing operator proficiency.

Déclaration de conflit d'intérêts

The following authors have declared that no competing interest exists: MTN, UH, HG, FF, NVH, AMF. I have read the journal's policy and JF as a Co-author of this manuscript has the following competing interests: personal fees from consultant for Microvention, Stryker, Cerenovus, Acandis, Penumbra and Medtronic outside the submitted work. He is a member of the Executive Board of the scientific societies DGNR and ESMINT. I have read the journal's policy and JHB as a Co-author of this manuscript has the following competing interests: personal fees from consultant for Microvention, Stryker, Cerenovus, Acandis and Medtronic outside the submitted work. The prepared patents for party of this model are currently reviewed by the corresponding authority: 1) Customizable training model with additively manufactured vessel models (review process, reference number 10 2019 008 058.0), 2) Training system with at least one blood vessel model (review process, reference number 10 2020 003 786.0); no other relationships or activities that could appear to have influenced the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.