Skip to main content
SpringerLink
Log in

Silicone models as basic training and research aid in endovascular neurointervention—a single-center experience and review of the literature

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

The rapid development and wider use of neurointerventional procedures have increased the demand for a comprehensive training program for the trainees, in order to safely and efficiently perform these procedures. Artificial vascular models are one of the dynamic ways to train the new generation of neurointerventionists to acquire the basic skills of material handling, tool manipulation through the vasculature, and development of hand-eye coordination. Herein, the authors present their experience regarding a long-established training program and review the available literature on the advantages and disadvantages of vascular silicone model training. Additionally, they present the current research applications of silicone replicas in the neurointerventional arena.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Acevedo-Bolton G, Jou LD, Dispensa BP, Lawton MT, Higashida RT, Martin AJ, Young WL, Saloner D (2006) Estimating the hemodynamic impact of interventional treatments of aneurysms: numerical simulation with experimental validation: technical case report. Neurosurgery 59(2):429–430

    Article  Google Scholar 

  2. Barath K, Cassot F, Rüfenacht DA, Fasel HD (2004) Anatomically shaped internal carotid artery aneurysm in vitro model for flow analysis to evaluate stent effect. AJNR Am J Neuroradiol 25(10):1750–1759

    PubMed  Google Scholar 

  3. Bendok BR, Parkinson RJ, Hage ZA, Adel JG, Gounis MJ (2007) The effect of vascular reconstruction device-assisted coiling on packing density, effective neck coverage, and angiographic outcome: an in vitro study. Neurosurgery 61(4):835–841

    Article  PubMed  Google Scholar 

  4. Cantón G, Levy DI, Lasheras JC (2005) Changes in the intraaneurysmal pressure due to HydroCoil embolization. AJNR Am J Neuroradiol 26(4):904–907

    PubMed  Google Scholar 

  5. Chueh JY, Wakhloo AK, Gounis MJ (2009) Neurovascular modelling: small batch manufacturing of silicone vascular replicas. AJNR Am J Neuroradiol 30(6):1159–1164

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Chueh JY, Wakhloo AK, Gounis MJ (2012) Effectiveness of mechanical endovascular thrombectomy in a model system of cerebrovascular occlusion. AJNR Am J Neuroradiol 33(10):1998–2003

    Article  CAS  PubMed  Google Scholar 

  7. Chung EM, Hague JP, Chanrion MA, Ramnarine KV, Katsogridakis E, Evans DH (2010) Embolus trajectory through a physical replica of the major cerebral arteries. Stroke 41(4):647–652

    Article  PubMed  Google Scholar 

  8. Du Mesnil de Rochemont R, Yan B, Zanella FE, Rüfenacht DA, Berkefeld J (2006) Conformability of balloon-expandable stents to the carotid siphon: an in vitro study. AJNR Am J Neuroradiol 27(2):324–326

    PubMed  Google Scholar 

  9. Ernemann UU, Grönewäller E, Duffner FB, Guervit O, Claassen J, Skalej MD (2003) Influence of geometric and hemodynamic parameters on aneurysm visualization during three-dimensional rotational angiography: an in vitro study. AJNR Am J Neuroradiol 24(4):597–603

    PubMed  Google Scholar 

  10. Fujimura N, Ohta M, Abdo G, Ylmaz H, Lovblad KO, Rüfenacht DA (2006) Method to quantify flow reduction in aneurysmal cavities of lateral wall aneurysms produced by stent implants used for flow diversion. Interv Neuroradiol 12(Suppl 1):197–200

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Gailloud P, Muster M, Piotin M, Mottu F, Murphy KJ, Fasel JHD, Rüfenacht DA (1999) In vitro models of intracranial arteriovenous fistulas for the evaluation of new endovascular treatment materials. AJNR Am J Neuroradiol 20(2):291–295

    CAS  PubMed  Google Scholar 

  12. Gobin YP, Counord JL, Flaud P, Duffaux J (1994) In vitro study of haemodynamics in a giant saccular aneurysm model: influence of flow dynamics in the parent vessel and effects of coil embolization. Neuroradiology 36(7):530–536

    Article  CAS  PubMed  Google Scholar 

  13. Gruber A, Bavinszki G, Killer M, Shameri A, Richling B (1998) In vitro training model for endovascular embolization of cerebral aneurysms. Minim Invasive Neurosurg 40(4):121–123

    Article  Google Scholar 

  14. Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75(1):8–14

    Article  CAS  PubMed  Google Scholar 

  15. Imbesi SG, Knox K, Kerber CW (2003) Aneurysm flow dynamics: alterations of slipstream flow for neuroendovascular treatment with liquid embolic agents. AJNR Am J Neuroradiol 24(10):2044–2049

    PubMed  Google Scholar 

  16. Kerber CW, Heilman CB (1992) Flow dynamics in the human carotid artery: I. Preliminary observations using a transparent elastic model. AJNR Am J Neuroradiol 13(1):173–180

    Google Scholar 

  17. Majidi S, Khatri R, Watanabe M, Siddiq F, Chaudhry SA, Qureshi AI (2012) Aneurysm embolization using detachable coils under intravascular ultrasonography guidance: an in vitro feasibility study. Neurosurgery 70(6):1557–1564

    Article  PubMed  Google Scholar 

  18. Malisch TW, Guglielmi G, Vinuela F, Duckwiler G, Gobin YP, Martin NA, Frazee JG (1997) Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg 87(2):176–183

    Article  CAS  PubMed  Google Scholar 

  19. Martin JB, Murphy KJ, Gailloud P, Sugiu K, Treggiari MM, Muster M, Guimaraens L, Théron JG, Rüfenacht DA (2001) In vitro evaluation of the effectiveness of distal protection in the prevention of cerebral thromboembolism during carotid stent placement. Acad Radiol 8(7):623–628

    Article  CAS  PubMed  Google Scholar 

  20. Matsubara N, Miyachi S, Nagano Y, Ohshima T, Hososhima O, Izumi T, Tsurumi A, Wakabayashi T, Sakaguchi M, Sano A, Fujimoto H (2009) A novel pressure sensor with an optical system for coil embolization of intracranial aneurysms. J Neurosurg 111(1):41–47

    Article  PubMed  Google Scholar 

  21. McDougall CG, Halbach VV, Dowd CF, Higashida RT, Larsen DW, Hieshima GB (1998) Causes and management of aneurismal hemorrhage occurring during embolization with Guglielmi detachable coils. J Neurosurg 89(1):87–92

    Article  CAS  PubMed  Google Scholar 

  22. Mehra M, Hurley MC, Gounis MJ, King RM, Shaibani A, Dabus G, Labdag FE, Levy EI, Bendok BR (2011) The impact of coil shape design on angiographic occlusion, packing density and coil mass uniformity in aneurysm embolization: an in vitro study. J Neurointerv Surg 3(2):131–136

    Article  PubMed  Google Scholar 

  23. Morris PP (2007) Practical neuroangiography. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  24. Müller-Hülsbeck S, Jahnke T, Liess C, Glass C, Paulsen F, Grimm J, Heller M (2002) In vitro comparison of four cerebral protection filters for preventing human plaque embolization during carotid interventions. J Endovasc Ther 9(6):793–802

    Article  PubMed  Google Scholar 

  25. Murphy KJ, Mandal S, Gailloud P, Clint H, Szoplnskl K, Qule H, Martin JB, Rüfenacht DA (2000) Neurovascular embolization: in vitro evaluation of a mechanical detachable platinum coil system. Radiology 217(3):904–906

    Article  CAS  PubMed  Google Scholar 

  26. Oechtering J, Kirkpatrick PJ, Ludolph AGK, Hans FJ, Sellhaus B, Spiegelberg A, Krings T (2011) Magnetic microparticles for endovascular aneurysm treatment: in vitro and in vivo experimental results. Neurosurgery 68(5):1388–1398

    PubMed  Google Scholar 

  27. Piotin M, Iijima A, Wada H, Moret J (2003) Increasing the packing of small aneurysms with complex-shaped coils: an in vitro study. AJNR Am J Neuroradiol 24(7):1446–1448

    PubMed  Google Scholar 

  28. Piotin M, Liebig T, Dalle Feste C, Spelle L, Mounayer C, Moret J (2004) Increasing the packing of small aneurysms with soft coils: an in vitro study. Neuroradiology 46(11):935–939

    Article  CAS  PubMed  Google Scholar 

  29. Piotin M, Mandai S, Sugiu K, Gailloud P, Rüfenacht DA (2001) Endovascular treatment of cerebral aneurysms: an in vitro study with detachable platinum coils and tricellulose acetate polymer. AJR Am J Roentgenol 176(1):235–239

    Article  CAS  PubMed  Google Scholar 

  30. Schloesser PE, Pakbaz RS, Levy DI, Imbesi SG, Wong WH, Kerber CW (2007) Analysis of complex framing coil stability in a wide-necked aneurysm model. AJNR Am J Neuroradiol 28(2):387–389

    CAS  PubMed  Google Scholar 

  31. Sorteberg A, Sorteberg W, Aagaard BDL, Rappe A, Strother CM (2004) Hemodynamic versus hydrodynamic effects of Guglielmi detachable coils on intra-aneurysmal pressure and flow at varying pulse rate and systemic pressure. AJNR Am J Neuroradiol 25(6):1049–1057

    PubMed  Google Scholar 

  32. Standard S, Chavis T, Wakhloo AK, Ahuja A, Guterman LR, Hopkins LN (1994) Retrieval of a Guglielmi detachable coil after unraveling and fracture: case report and experimental results. Neurosurgery 35(5):994–999

    Article  CAS  PubMed  Google Scholar 

  33. Sugiu K, Martin JB, Jean B, Gailloud P, Mandai S, Rüfenacht DA (2003) Artificial cerebral aneurysm model for medical testing, training and research. Neurol Med Chir (Tokyo) 43(2):69–73

    Article  Google Scholar 

  34. Sugiu K, Tokunaga K, Mandai S, Martin JB, Jean B, Rüfenacht DA (2003) Spiral versus J-shaped coils for neurovascular embolization-an in-vitro study. Neuroradiology 45(7):417–422

    Article  CAS  PubMed  Google Scholar 

  35. Sugiu K, Tokunaga K, Sasahara W, Watanabe K, Nishida A, Katsumata A, Kusaka N, Date I, Ohmoto T, Rüfenacht DA (2004) Training in neurovascular intervention. Usefulness of in-vitro model and clinical practice. Interv Neuroradiol 10(Suppl 1):107–112

    PubMed Central  PubMed  Google Scholar 

  36. Suzuki Y, Fujitsuka M, Chaloupka JC (2005) Simulation of endovascular neurointervention using silicone models: imaging and manipulation. Neurol Med Chir (Tokyo) 45(11):567–573

    Article  Google Scholar 

  37. Tanaka N, Martin JB, Tokunaga K, Abe T, Uchiyama Y, Hayabuchi N, Berkefeld J, Rüfenacht DA (2004) Conformity of carotid stents with vascular anatomy: evaluation in carotid models. AJNR Am J Neuroradiol 25(4):604–607

    PubMed  Google Scholar 

  38. Tateshima S, Tanishita K, Hakata Y, Tanoue SY, Viñuela F (2009) Alteration of intraaneurysmal hemodynamics by placement of a self-expandable stent. J Neurosurg 111(1):22–27

    Article  PubMed  Google Scholar 

  39. Tokunaga K, Tanaka N, Sugiu K, Levrier O, Martin JB, Rüfenacht DA (2002) Performance of long J-shaped coils in large and giant intracranial aneurysms: an in vitro study. Neuroradiology 44(3):261–267

    Article  CAS  PubMed  Google Scholar 

  40. Wakhloo AK, Gounis MJ (2008) Retrievable closed cell intracranial stent for foreign body and clot removal. Neurosurgery 62(5 Suppl 2):ONS390–ONS394

    PubMed Central  PubMed  Google Scholar 

  41. Watanabe K, Sugiu K, Tokunaga K, Sasahara W, Ono S, Date I (2007) Packing efficacy of hydrocoil embolic system: in vitro study using ruptured aneurysm model. Neurosurg Rev 30(2):127–130

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no personal financial interest in any of the materials or devices described in this article.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Srinivasan Paramasivam, Gerasimos Baltsavias, Evlampia Psatha, Georgios Matis & Anton Valavanis

Authors
  1. Srinivasan Paramasivam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gerasimos Baltsavias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Evlampia Psatha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georgios Matis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anton Valavanis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerasimos Baltsavias.

Additional information

Comments

Matthew Gounis, Worcester, USA

The article entitled “Silicone models as basic training and research aid in endovascular neurointervention—a single-center experience and review of the literature” by Srinivasan Paramasivam and colleagues describes the utility of silicone cerebrovascular replicas for training in endovascular techniques. Over the past decade, advances in 3D modeling and rapid prototyping have enabled a generation of anatomically accurate cerebrovascular models. This review is timely, as it emphasizes the need to develop solutions for comprehensive training as the dramatic increase in the availability of specialized interventional programs has subsequently decreased the volume available for endovascular training at academic medical centers [1]. The authors have trained an impressive 178 fellows in basic neurointerventional techniques using these silicone models. Moreover, the paper describes the necessity for advanced training of experienced interventionalists with new technology, namely, imaging systems and medical devices.

Numerous research studies that have advanced technology in neuroendovascular treatments using silicone vascular replicas are surveyed in this paper. The advantages of these models include reproducible engineering studies on hemodynamics and device characterization. Due to costs and societal sensitivities associated with animal experimentation, these models provide a viable alternative to address certain important questions in research of interventional neuroradiology. Researchers have seeded 3D vascular silicone models with endothelial cells [2], making a new generation of replicas that can serve as bioreactors. Yet other groups are working on new materials to generate vascular replicas that offer nearly identical tactile feedback with respect to the human cerebrovasculature. Advances in vascular replicas will continue to advance the discovery of improved technology for the treatment of cerebrovascular disease and offer enriching training programs for the foreseeable future.

Shahram Majidi, Washington, USA

This is an important study stressing the role of silicone models as a training aid in endovascular neurointerventional fellowship training. Paramasivam et al provided their experience in using silicone models as training tools in their endovascular neurointerventional fellowship program. The authors have more than 15 years of experience in training fellows in the field of endovascular surgical neurology and have trained more than 170 fellows. According to their experience, using silicone models has had significant impact on expanding fellows’ skills in handling and manipulating and navigating microcatheter and guidewire and also performing procedures such as coil embolization with or without stent assistance. As the authors nicely outlined, silicone models can be also used as valuable research tools. For instance, we can design and execute complex experiments investigating the hemodynamic changes within the aneurysm following stent deployment or compare different clot-retrieving devices in a safe in vitro setting without risk of harming the patient. These sorts of experiments are essential components of the field considering the fact that not all the hemodynamic and biophysical aspects of the devices are fully understood.

Current guidelines recommend minimum procedural volume requirements in order to reach acceptable operator experience and proficiency in performing endovascular procedures [3, 4]. For example, this number is 30 procedures for aneurysm coil embolization. There are very few teaching institutions in the USA which meet minimum requirements for all the procedures needed to reach adequate operator experience [5]. Therefore, it is essential to use adjunct training modalities such as silicone models or computer simulators in order to help the trainees obtain and maintain adequate procedural skills. Computer simulators have been used as a valuable adjunct training modality for endovascular procedure training with proven impact on trainees’ skill improvement [6]. Similarly, Dr. Paramasivam’s study is a successful example of necessity and value of using silicone models in neurointerventional fellowship training.

References

1. Cloft HJ. The neurointerventional bubble. AJNR Am J Neuroradiol. 2010;31:1162–1164.

2. Farcas MA, Rouleau L, Fraser R, Leask RL. The development of 3-D, in vitro, endothelial culture models for the study of coronary artery disease. Biomed Eng Online. 2009;8:30

3. Qureshi AI, Abou-Chebl A, Jovin TG. Qualification requirements for performing neurointerventional procedures: a Report of the Practice Guidelines Committee of the American Society of Neuroimaging and the Society of Vascular and Interventional Neurology. Journal of neuroimaging : official journal of the American Society of Neuroimaging. Oct 2008;18(4):433–447.

4. Connors JJ, 3rd, Sacks D, Furlan AJ, et al. Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American Academy of Neurology, the American Association of Neurological Surgeons, the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, the Congress of Neurological Surgeons, the AANS/CNS Cerebrovascular Section, and the Society of Interventional Radiology. Journal of vascular and interventional radiology : JVIR. Jul 2009;20(7 Suppl):S292–301.

5. Grigoryan M, Chaudhry SA, Hassan AE, Suri FK, Qureshi AI. Neurointerventional procedural volume per hospital in United States: implications for comprehensive stroke center designation. Stroke; a journal of cerebral circulation. May 2012;43(5):1309–1314.

6. Spiotta AM, Rasmussen PA, Masaryk TJ, Benzel EC, Schlenk R. Simulated diagnostic cerebral angiography in neurosurgical training: a pilot program. Journal of neurointerventional surgery. Jul 2013;5(4):376–381.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paramasivam, S., Baltsavias, G., Psatha, E. et al. Silicone models as basic training and research aid in endovascular neurointervention—a single-center experience and review of the literature. Neurosurg Rev 37, 331–337 (2014). https://doi.org/10.1007/s10143-014-0518-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-014-0518-x

Keywords

Search

Navigation