By Laura Eggertson

The first time Dr. David Volders used a simulation device to practise threading a tiny catheter into people’s brain arteries to remove life threatening blood clots, he realized the experience was a game-changer.

Dr. Volders is an interventional neuroradiologist and Associate Professor at Dalhousie’s Faculty of Medicine. He specializes in treating people who have strokes, caused by clots that block the blood supply to the brain. He also treats aneurysms, which occur when a weakened artery wall bulges or ruptures.

Every year, Dr. Volders and his colleagues at the QEII Hospital in Halifax perform more than 100 highly specialized procedures called endovascular thrombectomies, or EVTs.

To be successful, the doctors must be confident, and they have to be fast. To gain these skills, they need expert training—training Dr. Volders provides as director of Dalhousie’s neuroradiology program.

Now, thanks to a $415,000 Mentice digital training device and software the QEII and Dalhousie are purchasing, trainees on Volders’ team and across Atlantic Canada will be able to practise performing EVTs and other neurointerventional procedures in a simulated setting, with no risk to patients.

QEII Foundations, Dalhousie partner

The QEII Foundation has contributed $200,000 to the project through its $100-million We ARE campaign, and the Faculty of Medicine is contributing the remainder, in part by seeking philanthropic donations.

Dalhousie will be one of only three medical schools in Canada with this top-of-the-line simulation equipment.

“We’ll definitely have the best equipment in Canada for training people,” Dr. Volders says.

Acquiring the Mentice device would not be possible without generous donors, say Dr. Volders and Ms. Susan Mullin, President and CEO of the QEII Foundation.

“This groundbreaking technology offers an unparalleled simulation experience, allowing our health-care teams at the QEII and beyond to practise and perfect intricate, life-saving procedures in a risk free environment,” Ms. Mullin says.

“We’re incredibly proud to partner with Dalhousie on this leading edge initiative, and we’re grateful for the many QEII Foundation and Dalhousie donors who are coming together to make this milestone a reality.”

Donors’ inspiring support will play “an instrumental role in improving patient care and training, recruiting, and retaining medicine’s best and brightest care providers,”

Ms. Mullin adds. Acquiring this simulation training device has real clinical benefit, Dr. Volders agrees.

“There is a direct return to our patients in terms of making diagnoses and avoiding complications,” he says.

An EVT is a minimally invasive procedure performed in a specialized angio suite where doctors use X-ray images to guide a catheter into the brain vessels, either from an artery in a patient’s wrist or groin. To remove the brain clot, Dr. Volders then uses either suction from a catheter or a stent-retrieving device to reopen the blood vessel and restore the blood flow.

For a brain aneurysm, he uses a tiny catheter that is placed inside of the aneurysm to create a basket of metal coils to close of the aneurysm from the inside. This procedure significantly reduces the risk of future bursting.

Every second counts. Every moment a clot blocks blood flow to the brain, a patient loses 2 million brain cells—causing potentially permanent brain damage and loss of function.

Previously, people learning to perform this procedure had to learn by watching someone more experienced and then by doing it themselves, under supervision, before finally operating on their own. That is an anxiety-provoking training method that can lead to mistakes, Dr. Volders says.

“There’s been a tremendous advancement in our field, but what hasn’t advanced at the same pace is how you train people to do these procedures,” he says.

Currently, there is more than 10 percent chance that a medical trainee learning to perform EVT will cause an additional stroke or damage a patient’s brain, simply because they have no other way of practising this procedure except by performing it, Dr. Volders says.

Experience reduces risk, saves lives

By contrast, experienced neuroradiologists like Dr. Volders have only a .5 percent risk of adverse events, because they have had hundreds of opportunities to hone their skills.

John Whidden is one of the patients who benefitted from Dr. Volders’ experience and skill. In 2020, he had a stroke after blood clots formed in his brain and neck. Thanks to Dr. Volders’ quick intervention in performing an EVT, Whidden recovered completely—and he’d like other patients to benefit from doctors trained in the latest simulation methods.

“This kind of simulation is going to be a lifesaver,” Whidden says. “The more equipment that’s available to people to increase their expertise, the better—that’s wonderful.”

By practising on the Mentice device, trainees, including staff members, fellows, residents, or medical students, can learn in a safe, simulated setting that feels similar to performing the actual surgery, without the pressure of learning on a patient.

“The impact on patients’ lives is going to be tremendous,” Dr. Volders says. “With this tool, you can train as much as you want, the more experienced you are, the fewer complications you have.”

The software accompanying the machine loads actual patient brain scans for surgeons and trainees to review before they perform an EVT.

Instructors can also load practice scans where supervisors like Dr. Volders can program potential complications, so the trainees learn how to respond to these emergencies. An entire healthcare team can use the Mentice device to practise their roles during a surgery, or an individual can train on it.

In addition, the neuroradiology group can purchase additional software to let doctors in other specialties train and practise their operations.

Dr. Volders plans to invite neuroradiologists from outside Nova Scotia, such as those in smaller centres in New Brunswick and Prince Edward Island, to come to Halifax to train on the Mentice device so they can learn to perform this delicate surgery at their own hospitals.

That training would improve the care to stroke victims outside Halifax, who often lose valuable time getting to the QEII via helicopter or ambulance.