Suchergebnisse

Introduction: Working Time Regulations in Europe allied with the endovascular revolution require vascular surgeons to be innovative in achieving competence during their training period. We evaluated the feasibility of eLearning to teach the use of OsiriX for sizing and planning endovascular aortic aneurysm repairs. Materials and Methods: Eight blended learning modules were constructed, consisting of instructional PDFs, demonstration videos, CT angiogram downloads for individual practice and online support forums. These were delivered online over a nine-week period. The learning material encompassed an introduction to the OsiriX interface, the basic skills to use OsiriX for sizing and planning of aneurysm repairs and advanced techniques for reconstruction and online communication relating to imaging. Results: The course was successfully delivered and produced positive feedback from registered users. A high rate of dropouts occurred during the early phase. The design and implementation of a fully web-based course by full time clinicians utilising multimedia and user forums to teach vascular surgeons the performance of a practical skill is feasible. Conclusions: A modular instructional course offered online by vascular surgeons is feasible in teaching clinicians the use of OsiriX for 3D reconstructions of CT angiograms of aortic aneurysms. Shortening course duration may improve compliance. The instructional model is effective and well received by compliant learners.

BACKGROUND: Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. METHODS: Patients with symptomatic carotid stenosis were randomly assigned 1:1 to open treatment with stenting or endarterectomy at 50 centres worldwide. Randomisation was computer generated centrally and allocated by telephone call or fax. Major outcomes were assessed by an independent endpoint committee unaware of treatment assignment. The primary endpoint was fatal or disabling stroke in any territory after randomisation to the end of follow-up. Analysis was by intention to treat ([ITT] all patients) and per protocol from 31 days after treatment (all patients in whom assigned treatment was completed). Functional ability was rated with the modified Rankin scale. This study is registered, number ISRCTN25337470. FINDINGS: 1713 patients were assigned to stenting (n=855) or endarterectomy (n=858) and followed up for a median of 4·2 years (IQR 3·0-5·2, maximum 10·0). Three patients withdrew immediately and, therefore, the ITT population comprised 1710 patients. The number of fatal or disabling strokes (52 vs 49) and cumulative 5-year risk did not differ significantly between the stenting and endarterectomy groups (6·4% vs 6·5%; hazard ratio [HR] 1·06, 95% CI 0·72-1·57, p=0·77). Any stroke was more frequent in the stenting group than in the endarterectomy group (119 vs 72 events; ITT population, 5-year cumulative risk 15·2% vs 9·4%, HR 1·71, 95% CI 1·28-2·30, p<0·001; per-protocol population, 5-year cumulative risk 8·9% vs 5·8%, 1·53, 1·02-2·31, p=0·04), but were mainly non-disabling strokes. The distribution of modified Rankin scale scores at 1 year, 5 years, or final follow-up did not differ significantly between treatment groups. INTERPRETATION: Long-term functional outcome and risk of fatal or disabling stroke are similar for stenting and endarterectomy for symptomatic carotid stenosis. FUNDING: Medical Research Council, Stroke Association, Sanofi-Synthélabo, European Union.