According to Christopher Cates, MD, director of vascular intervention at Emory Hospitals, by using hands-on simulation, physicians are learning to capture and remove blood clots in the brain through catheter-based treatments similar to the life-saving treatments used to stop a heart attack.
"In the event of a heart attack, 'time is muscle', and in the event of a stroke, 'time is brain tissue'. Quick intervention can mean the difference between a full recovery and disability or even death7quot;, stated Dr. Cates, who is also SCAI secretary and the training programme's national director.
Cardiologists who participate in the course are able to practise removing a clot from the brain in the cardiac catheterization lab under the simulated circumstances that match what they would experience while treating a stroke patient. They practise using the new interventional devices and experience what it looks like and even what it feels like to remove the clot from the blood vessels of the brain.
The programme, developed for cardiologists already experienced in coronary and carotid artery stenting, introduces physicians to acute stroke intervention and provides hands-on simulation in clot removal. Each session is limited to 20 experienced interventional cardiologists in order to provide extensive hands-on training, allowing participants to practise removing clots from the brain on a unique simulation system.
Clots are removed using a newly FDA-approved catheter-based clot-retrieval device. Physicians thread a guide wire to the clot through the carotid arteries in the neck. The wire is threaded through the clot, and when the device is deployed, the coiled wire wraps around the clot, acting like a basket and allowing the physician to pull the whole clot from the body and restore blood flow to the brain.
In 2007, representatives from interested medical disciplines, industry and government convened the first Stroke Roundtable to develop guidelines and conduct research on stroke. SCAI was the first organisation to launch a stroke intervention course in late 2007, "Advanced Course in Carotid Stenting". The Introductory Neuro Rescue course is the first course of its kind to provide acute stroke intervention simulation training for cardiologists.
"Interventional treatments are the future of stroke care. With advances in treating carotid artery disease with stenting, it is important for cardiologists to be trained to stop strokes", stated Dr. Cates' colleague and former SCAI president Bonnie H. Weiner, MD. "New interventional treatments are showing great promise in stopping stroke, just as similar treatments have revolutionized heart attack care over the past 30 years and dramatically reduced death rates."
A key challenge now is to train a sufficient number of physicians around the country to deliver these important treatments and raise awareness among patients about the importance of seeking care quickly if they experience symptoms of stroke. As the procedure evolves, SCAI will also work with other societies and agencies to assess the effectiveness of these interventions against existing benchmarks for the treatment of stroke.
Using virtual reality or simulation technology, physicians can now practise risky catheter-based procedures, such as carotid stenting, on a virtual patient simulator, using the patient's exact anatomical data - and then perform the exact same technique on the live patient once the procedure has been mastered.
"Simulation training could help reduce medical errors that are estimated to cause between 44.000 and 94.000 deaths in the United States each year", stated Dr. Cates. "Many of these deadly mistakes are caused by human factors associated with invasive, image guided procedures learned in the traditional way, with doctors learning new procedures working on patients with the guidance of experienced teachers."