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INTERVENTIONS FOR HYPERTENSION AND STROKE

Our experience training a neurocardiologist: a case for an emerging specialty

Sanford Health, Fargo, ND, USA

Treatment of acute ischaemic stroke with mechanical thrombectomy is now supported with level 1 evidence1. The vast majority of thrombectomies are currently performed by neurointerventionalists. Unfortunately, the current supply of neurointerventionalists is inadequate; while there is only one cerebrovascular neurosurgery programme in our region, there are nine established ST-elevation myocardial infarction (STEMI) programmes. To address this shortcoming, we believe that the established STEMI infrastructure may serve as a bridge.

We propose a model where interventional cardiologists interested in treating acute ischaemic stroke can be trained as “neurocardiologists” in a systematic and controlled fashion. We have adopted a structured approach to stroke neurointervention training that includes teaching clinical assessment skills of the patient in the emergency room, interpretation of imaging and clinical data, decision-making skills as they relate to thrombectomy, as well as performance of thrombectomy itself. The baseline technical requirements include independent performance and review of 100 cerebral angiograms, placement of 25 carotid stents, as well as supervised performance of at least 25 mechanical thrombectomies. Specific training related to obtaining appropriate access, navigating the cerebral circulation, use of stroke-specific devices, and complication avoidance and management is emphasised. Trainees are required to attend stroke codes, spend time with stroke neurology, diagnostic neuroradiology, cerebrovascular neurosurgery, and to see patients postop in the neuro intensive care unit for a period of six months. In accordance with the Standards of Practice in Interventional Neuroradiology, the trainee is constantly mentored and supervised by the staff cerebrovascular neurosurgeons who can manage complications by both endovascular and open surgical means2. Once the cerebrovascular neurosurgeon gives approval, the neurocardiologist may independently cover a stroke call. Here we present the early experience of a single independent neurocardiologist immediately following such training.

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