Authors
Klimovsky S.D., Ghazaryan G.G., Krichman M.D., Mirilashvili T.Sh.
City Clinical Hospital named after A.K. Yeramishantsev, Moscow
Abstract
Rationale: Endovascular intervention is often the first-line treatment for patients with intracranial artery pathology. Specialists performing therapeutic interventions on cerebral vessels must have practical training, since the cost of error is extremely high. For this reason, these interventions are performed by residents and interns less often than other endovascular surgeries. Printing of 3D models is a unique educational tool that can improve the effectiveness of training in endovascular techniques. However, to date, the role of this new technology in training specialists, as well as the features of its application, have not been sufficiently covered.
Objective: to analyze the effect of 3D printing of an individually recreated digital model of vascular structures of the brain on the results of training and education in the technical aspects of endovascular neurointerventions.
Materials and methods: At the first stage of the study, an analysis of the fundamental possibility of 3D printing was carried out, based on an individually recreated digital three-dimensional model of vessels (using the carotid artery bifurcation as an example). Silicone was selected as the raw material for 3D printing. It was found that when printing with one-component silicone, there is significant ribbing of the model. Two-component silicone compounds were tested; their compliance with the required characteristics of the vascular model in terms of optical transparency and strength was demonstrated. 20 variants of carotid artery bifurcation models were manufactured. The task of the second stage was to create 3D models of vascular structures of a more complex shape and a smaller internal diameter than at the first stage. As a result, 3D models were designed and samples of cerebral arteries (2-5 mm) were created on their basis. At the third stage, the arterial vascular models were used for training in endovascular neurointerventions.
Results: Five endovascular surgeons (with conditional numbers 1-5) took part in the simulation training. None of them managed to successfully complete all 10 attempts, while at least one success was recorded for all of them. Number of successful attempts: 8, 7, 7, 1, 3 respectively. Number of attempts to the first success: 1, 2, 1, 7, 6. Time spent on a successful attempt (M±σ): 25±8, 30±12, 45±15, 45, 65/60 min. Overall assessment of the effectiveness and feasibility of the simulation training by the surgeon on a 5-point scale: 3, 4, 5, 5, 3. Most of the training participants noted the low realism of the models and the discrepancy between the characteristics of the inner wall of the model and the real endothelium of the vessel: the silicone was too rigid, which limits its use as a training prototype.
Conclusion: 3D printing of vascular structures for the purpose of practicing in neurovascular intervention seems to be a promising technique. The first experience demonstrated that its implementation is accompanied by significant difficulties associated with both the initial experience the new method and with the existing limitations of the technology itself.
Keywords: intracranial arteries, endovascular intervention, three-dimensional modeling, 3D printing, training.
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