Development of Simulator System Using Endovascular Evaluator for Catheter Intervention Training

Objective: We formulated a simulator system for catheter intervention training by developing a sliding table and an electrically controlled camera-holding C-arm and combining them with the silicone vessel model EndoVascular Evaluator (EVE). We performed simulation of mechanical thrombectomy using this system and evaluated its usability for simulation training. Methods: After three experts in neuroendovascular treatment were given instructions for the use of this system, they performed mechanical thrombectomy by a procedure as close as possible to that in clinical situations using an artificial thrombus model simulating left middle cerebral artery occlusion, and the procedural times and maneuvers were studied. The time required for guiding catheter placement in the cervical internal carotid artery (guiding time), time required for stent placement (stent placement time), and time required for retrieval of thrombus together with the stent (stent retrieval time) were measured, and the number of movements of the sliding table and C-arm during the procedure were counted. Results: The intended procedure could be executed faithfully by all physicians. The mean guiding, stent placement, and stent retrieval times were 185 ± 18, 387 ± 33, and 616 ± 27 seconds, respectively. The mean numbers of table and C-arm movements during the procedure were 14 ± 1.7 and 8.3 ± 0.5, respectively. Conclusion: This system allows operators to faithfully reproduce the mechanical thrombectomy procedure and is considered to have functions necessary for simulation training of catheter intervention and performance assessment.