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Objectives: The purpose of this study was to determine whether performance on a simulator model of carotid artery stenting correlates with previous endovascular experience and to assess the effects of repetition and training. Methods: Participants were stratified to untrained and advanced skill groups on the basis of number of endovascular procedures previously performed. Baseline performance was assessed by means of a pretest, and participants were randomized to practice and no-practice groups. Practice consisted of a 30-minute to 60-minute proctored session before taking a final test; those in the no-practice group proceeded directly to the final test without this session. Primary outcomes were completion of a standardized protocol and the length of time needed to complete all steps. Results: Twenty-nine subjects (16 untrained, 13 advanced) participated fully in the study. Ninety-two percent of participants in the advanced group successfully completed the pretest, versus 63% in the untrained group (P = .09); mean time to successful completion was 29.9 +/- 4.8 (mean +/- SD) versus 48.0 +/- 9.9 minutes, respectively (P < .001). Subjects who received no practice did not significantly improve their completion times between pretest and final test, whereas those who received practice did (novice, 47.9 +/- 7.0 minutes vs 24.5 +/- 2.9 minutes, P < .001; advanced, 29.6 +/- 3.1 minutes vs 20.2 +/- 4.1 minutes, P < .001). The group without previous training had significantly more time improvement from training than did the advanced group. Exit survey results showed that those who had the opportunity to practice more commonly believed that the simulator increased their endovascular skills and interest in vascular surgery (both P < .01 vs untrained group). Conclusions: Performance on the carotid stenting simulator correlated with previous endovascular experience. Although both novice and advanced groups improved their time after a 30-minute to 60-minute proctored training session, improvement in the novice group was greater than that in the advanced group, which suggests that novices may benefit disproportionately from this type of training.

Our objective was to examine and correlate 99mTcdiethylenetriaminopentaacetic acid 99mTcDTPA ventilation and 99mTcmacroaggregated albumin 99mTcMAA perfusion VQ lung scans with spirometry in asymptomatic asthmatic children. We evaluated 89 subjects age range, 6–15 years mean age, 9.4 years, all with at least 70 predicted forced expiratory volume in 1 s FEV1. There were four VQ scan patterns normal in 38 42.7, inhomogeneous ventilation in 11 12.4, matched defects in 25 28.3 and mismatched perfusion defects in 13 14.6. The maximal midexpiratory flow rate MMEF of the normal scan group was significantly different from that in the other groups. The MMEF of the inhomogeneous group was significantly different from that in the matched defect group and the mismatched perfusion defect group. No other significant differences in spirometric indices were found. In two children with perfusion defects, pulmonary arteriograms demonstrated no obstructive lesions. In conclusion, lung scans provide diagnostic information in asymptomatic asthmatic children, even when they are uncooperative. Abnormal scans are common in these children and are significantly correlated with reduced MMEF predicted, reflecting small airway flow obstruction. The pathophysiology of VQ defects in asymptomatic asthmatic children warrants further investigation.