Neurointervention.  2024 Jul;19(2):102-105. 10.5469/neuroint.2024.00094.

A Novel Training Method for Endovascular Clot Retrieval Using a Portable Vascular Model and Red Film

• Ioku T
• Ohshima T
• Kawaguchi R
• Matsuo N
• Miyachi S

• KMID: 2556661
• DOI: http://doi.org/10.5469/neuroint.2024.00094

Abstract

Hands-on training is a crucial part of education in neuroendovascular treatment to ensure safe and rapid acquisition of techniques. However, there is a significant gap between training and actual clinical practice. This study will introduce innovations for more practical thrombus retrieval training that was developed in this process. A Smart Vascular Model 3 in 1 was used. A pink pseudothrombus was inserted into the M1 (horizontal segment of the middle cerebral artery) section of the model. Then, a “red underlay” purchased at a stationery store was placed to cover the proximal part of M1 and beyond so that the pseudothrombus was not visible. The thrombus was retrieved during training by looking for the location of the thrombus based on the behavior and resistance of the tip of the guidewire and deployment of the stent retriever. The participants were required to have detailed observation skills and precise manipulation skills using a red film to prevent the direct visualization of the pseudothrombus. The implementation of this innovation to the previous hands-on training made the training more practical and effective. If the exact thrombus location can be determined by the behavior of the wire tip, the device’s capabilities can be maximized, and rapid retrieval can be expected. It could also reduce complications, as unnecessary peripheral guidance of the device could be avoided.

Keyword

Neuroendovascular treatment; Red film; Training; Vascular model

Figure

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  Fig. 1. (A) Smart Vascular Model 3 in 1 (Nihon Light Service Inc.). (B) A pink pseudoclot was placed in the vessel. (C–E) Vascular model during clot retrieval using a large J-shaped guidewire. (C) When the red film was covered, the pseudothrombus became completely invisible (white arrow). A large J-shaped guidewire was used to pass through the blockage. (D) The white arrowhead indicates the tip of the curved guidewire. (E) The microcatheter was navigated into the far distal vessel (arrowhead). (F–H) Vascular model during clot retrieval using a small J-shaped guidewire. (F) When the guidewire contacted the invisible pseudothrombus (white arrow), it deflected, and the origin of the thrombus could be ascertained. (G) Once the guidewire passed through the thrombus and reached the true lumen of the vessel, the wire tip was free (white arrowhead), and the distal end of the thrombus could be recognized. (H) The microcatheter could be guided into the appropriate position (arrowhead).

Reference

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