More News

And he goes by the name Simantha, a computerized mannequin that has been assisting doctors training in new stent techniques.

‘‘These cases are designed from real cases by physicians evaluating new technologies to treat blockages in these carotid arteries that can lead to strokes,” said Mark Turco, director of the Center for Cardiac and Vascular Research at Washington Adventist Hospital in Takoma Park. ‘‘This kind of training has been around a long time, in the military, in aerospace technology. ... We’re just now playing catch-up.”

Turco was one of a handful of doctors at Washington Adventist Hospital who practiced carotid artery procedures using new stents in a 35-foot bus, or ‘‘mobile training unit,” parked outside the hospital last week. The training was provided by Boston Scientific, the Massachusetts-based manufacturer of the new stent, or ‘‘NexStent,” a tubular device used for patients with a high risk for stroke that expands patients’ carotid arteries.

Simantha is the training unit’s brave patient — a mannequin hooked up to a life-like heartbeat and blood pressure monitor. Simantha ‘‘feels” pain and is prone to complications.

The simulated procedure begins with a rundown of the patient’s history, presented by a nurse on a screen above the mannequin’s head. This is followed by a series of X-rays that gives the doctors a glimpse of the patient’s problem areas and a good idea where a stent would help to fix arteries blocked by plaque.

During a real procedure, the patient would be awake. An anesthetic would be administered to numb the area where the doctor would insert the stent and a filter to catch blood clots and plaque displaced during the procedure.

Turco’s nurse and technician was ‘‘played” by Edwin Gonzalez, a clinical education specialist who travels with Boston Scientific. He monitors Simantha’s vitals, assists the doctors when they misstep or gives advice on how to proceed.

‘‘It’s all a very real environment. What makes it even more real is the tools that we use,” Turco said, holding up filter wires similar to those used in the hospital’s Catheter Lab.

Stops on the bus tour were chosen by Boston Scientific based on hospitals’ levels of interest in introducing the new stents in their carotid procedures, said Barb Polman, a spokeswoman with the company. Others nearby have included Winchester Medical Center in Winchester, Va., and Inova Fairfax Hospital in Fairfax, Va. Two buses from Boston Scientific are equipped for the training and make 10 stops a week at hospitals nationwide.

There are other hospitals in the area that offer carotid stenting procedures with different kinds of stents, but those hospitals did not participate in the Boston Scientific training.

The first carotid stent was approved for use by the Food and Drug Administration in 2004. Boston Scientific’s version is the fourth approved device used as an alternative to more invasive surgical procedures. Washington Adventist Hospital will launch its own use of the NexStent this week.

‘‘It’s something that’s become much more common in the last two years,” said Wayne Olan, director of interventional neuroradiology at Suburban Hospital in Bethesda. Olan added that stents are used more often than surgery in patients who are ‘‘medically difficult,” have had recurrent blocked carotid arteries or previous surgeries.

Recent studies comparing surgery to stenting have come up with a wide range of results. A controversial French study of 527 patients with carotid-artery disease last year was cut short after investigators found that stenting was proving too risky when compared to the surgical alternative.

A recent expanded trial called the Carotid Endorectomy Stent Trial (CREST) hopes to eventually provide more evidence. Washington Adventist Hospital, Johns Hopkins Hospital in Baltimore and Anne Arundel Medical Center in Annapolis will contribute to the estimated 2,500 patients CREST organizers hope participate in the trial. The trial is sponsored by the National Institutes of Health.

Whether stenting procedures are covered by insurance is set by the Centers for Medicaid and Medicare Services (CMS). The CMS recently proposed expanding its insurance coverage policy for stenting to include patients whose carotid arteries are more than 80 percent blocked and are at a high risk for carotid artery disease.

While costs can vary by site, Turco said the stent and filter run between $2,500 and $3,000. This would not include the cost of the one-day hospital stay and a procedure fee.

‘‘Many centers are CMS-certified, but there’s not that many physicians doing it,” Turco said of carotid artery stenting.

The most serious, but rare, complications from carotid stenting include mini-strokes, kidney damage and blood clots that lead to strokes. More commonly, patients experience mild bruising or tenderness in the wounds through which the doctors insert the stents and filters. During Boston Scientific’s tutorials, Simantha suffers complications. During Turco’s procedure, the patient survived a severe drop in blood pressure, and Turco had some trouble fitting the filter wire through the stent.

‘‘I love it. It looks gorgeous,” Gonzalez said after Turco expanded the stent in Simantha’s right carotid artery.

‘‘It’s fun, but it can be stressful,” Turco said after the simulated procedure. ‘‘It’s a nice, relaxed environment until something bad happens. ... It’s better that it happens here than in the [Catheter] Lab.”

Facts about strokes

Stroke is the third leading cause of death in the United States and the No. 1 cause of disability in adults.

Up to 15 percent of strokes are caused by carotid artery disease.

More than 700,000 Americans will have new (500,000) or recurrent (200,000) strokes each year, and 280,000 will die from stroke.

The lifetime cost of stroke exceeds $90,000 per patient in the United States.