Impact and prevention of errors in endovascular treatment of unruptured intracranial aneurysms

Abstract

Background Preventing errors and complications in neurointervention is crucial, particularly in the treatment of unruptured intracranial aneurysms (UIAs), where the natural history is generally benign, and the margin of treatment benefit small. We aimed to investigate how neurointerventionalists perceive the importance and frequency of errors and the resulting complications in endovascular UIA treatment, and which steps could be taken to prevent them. Methods An international multidisciplinary survey was conducted among neurointerventionalists. Participants provided their demographic characteristics and neurointerventional treatment volume. They were asked about their perceptions on the importance and frequency of different errors in endovascular UIA treatment, and which solutions they thought to be most effective in preventing these errors. Results Two-hundred-thirty-three neurointerventionalists from 38 countries participated in the survey. Participants identified errors in technical execution as the most common source of complications in endovascular UIA treatment (40.4% thought these errors constituted a relatively or very large proportion of all complication sources), closely followed by errors in decision-making/indication (32.2%) and errors related to management of unexpected events (28.4%). Simulation training was thought to be most effective in reducing technical errors, while cognitive errors were believed to be best minimized by abandoning challenging procedures, more honest discussion of complications and better standardization of procedure steps. Conclusion Neurointerventionalists perceived both technical and cognitive errors to be important sources of complications in endovascular UIA treatment. Simulation training, a cultural change, higher acceptance of bail-out strategies and better standardization of procedures were perceived to be most effective in preventing these.

School of Thrombectomy—A 3-Step Approach to Perform Acute Stroke Treatment with Simulator Training and Virtual Supervision by Remote Streaming Support (RESS)

“…These results are in line with our findings: all of our trainees rated the learning and practice effect of the initial simulator training at the end of the curriculum as very valuable. Simulation training has also been described to be one important factor in preventing technical and cognitive errors that may result in complications during neuroendovascular procedures [ 5 , 16 ]. In this context, our study participants rather disagreed that the simulator approach provides awareness of typical complications during endovascular procedures.…”

Utility of medical simulation in neurovascular critical care education

“…In addition, Ospel et al [51] conducted an international multidisciplinary survey, with the intention of determining the point of view of neurointerventionalists about the errors regularly committed in the endovascular treatment of unruptured intracranial aneurysms. They found that the faults that most regularly caused complications were related to technical execution and suggested that these faults can be prevented by strengthening the abilities of medical personnel through training in simulation settings.…”

“…They found that the faults that most regularly caused complications were related to technical execution and suggested that these faults can be prevented by strengthening the abilities of medical personnel through training in simulation settings. As a result, it would be ideal for simulation to be widely available to physicians and to become a part of the equipment in intervention centers, similar to surgical specialties that use this learning modality permanently in their academic training program [51][52][53].…”