The use of video motion analysis to determine the impact of anatomic complexity on endovascular performance in carotid artery stenting

Abstract

Objective: Video motion analysis (VMA) uses fluoroscopic sequences to derive information on catheter and guidewire movement and is able to calculate two-dimensional catheter tip path length (PL) on the basis of frame-by-frame pixel coordinates. The objective of this study was to evaluate the effect of anatomic complexity on the efficiency of completion of defined stages of simulated carotid artery stenting as measured by VMA.Methods: Twenty interventionists each performed a standardized easy, medium, and difficult carotid artery stenting case in random order on an ANGIO Mentor (Simbionix, Airport City, Israel) simulator. Videos of all procedures were analyzed using VMA software, and performance was expressed in terms of two-dimensional guidewire tip trajectory distance (PL). Comparisons of PL were used to identify differences in cannulation performance of the participants between the three cases of varying difficulty. The procedure was subdivided into four procedural phases: arch navigation, common carotid artery (CCA) cannulation, external carotid manipulation, and carotid lesion crossing. Comparisons of PL were used to identify differences in performance between the three cases of varying difficulty for each of the procedural phases.Results: There were significant differences in PL in relation to anatomic complexity, with a stepwise increase in PL from easy to difficult cases: easy, median of 5000 pixels (interquartile range, 4075-5403 pixels); intermediate, 9059 (5974-14,553) pixels; difficult, 17,373 (11,495-26,594) pixels (P < .001). Similarly, during CCA cannulation, there was a stepwise increase in PL from easy to difficult cases: easy, 749 (603-1403) pixels; intermediate, 3274 (1544-8142) pixels; difficult, 8845 (5954-15,768) pixels (P < .001). There were no observed differences across the groups of anatomic difficulty for the phases of arch navigation, external carotid manipulation, and carotid lesion crossing.Conclusions: Increasing anatomic complexity leads to significant increases in PL of endovascular tools, in particular during CCA cannulation. This increase in tool movement may have a bearing on clinical outcome.

A Systematic Review of Simulation-Based Training in Vascular Surgery

“…ANGIO Mentor, a high-fidelity VR simulator, was validated by twelve studies as seen in Supplementary Table III . 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 Willaert et al. scored 2/2 for content by implementing an expert validated assessment scale on 20 endovascular experts and outlined a clear method of test design and standardization, scoring highly for response process (rating = 2/2).…”

“…ANGIO Mentor, a high-fidelity VR simulator, was validated by twelve studies as seen in Supplementary Table III. [36][37][38][39][40][41][42][43][44][45][46][47] Willaert et al scored 2/2 for content by implementing an expert validated assessment scale on 20 endovascular experts and outlined a clear method of test design and standardization, scoring highly for response process (rating ¼ 2/2). 40 Maertens et al demonstrated in two studies that ANGIO Mentor could differentiate between endovascular performance in 32 surgical trainees and additionally 20 vascular surgeons and 29 medical students.…”

Evaluation of Robotic-Assisted Carotid Artery Stenting in a Virtual Model Using Motion-Based Performance Metrics

“…In this study, the simulator served as a platform wherein the same cases could be repeated in a standardized environment; therefore, we were able to evaluate solely the navigational performance of the participant and the treatment modality. Rolls et al 27,28 used a similar method to evaluate catheter path length in CAS with varying anatomical complexity. The simulator metrics provide an objective and quantitative evaluation of the operator’s performance immediately after concluding the case.…”

The smart angiography suite

“…[14][15][16] Researchers are also using VMA to study catheter movement on fluoroscopic images for potential applications. 17 Besides VMA, creative video compression algorithms can also be used to select out relevant highlight clips for efficient research analysis or audits. 18 Video processing algorithms will further maximize the research value of SAS video records.…”