In a joint, global position statement, the Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE) and the Interventional Radiology Society of Australasia (IRSA) have committed to providing necessary stroke training to interventional radiologists in order to alleviate the shortage of physicians trained in endovascular stroke therapies.
The ability for patients to access thrombectomy-capable stroke centers remains stymied by geography and a shortage of interventional physicians, despite the American Heart Association’s and multiple international stroke organizations’ recommendations that endovascular thrombectomy (EVT or clot removal) be the standard of care for patients suffering acute ischemic stroke caused by blocked arteries.
“The shortage of physicians and comprehensive stroke centers providing EVT has been confirmed by the stroke neurology community, who recommend that patients be treated locally rather than having long transfer delays,” the joint statement said. “Appropriately trained interventional radiologists can evaluate stroke patients and provide emergent EVT with good outcomes … especially where neurointerventional physicians are not available.” Interventional radiologists can also help provide 24/7 care in partnership with neurointerventional physicians where they are available, the statement said.
Endovascular thrombectomy is proven to save lives and improve outcomes for patients suffering acute ischemic strokes. Patients who undergo these clot-removing treatments not only survive in greater numbers, but also have fewer resulting disabilities and are able to recover functions faster than best medical therapy.
“Reversing symptoms from these strokes requires rapid and safe removal of the occluding thrombus,” the societies said in the statement. Allowing interventional radiologists to join their neurology, neurointerventional and neurosurgeon colleagues on care teams and allowing them to be part of certified stroke centers will greatly increase access to this critical treatment, they said.
SIR is already revising its current stroke training guidelines to support expanded patient access to interventional stroke treatment. The training pathway will reinforce Joint Commission and American Heart Association requirements for physicians operating in Thrombectomy-capable Stroke Centers (TSCs) and Comprehensive Stroke Centers (CSCs). In September, the Joint Commission and American Heart Association announced they would hold a dialogue with provider organizations to discuss requirements as the organizations work to update certification criteria for TCSs and CSCs.
“SIR strongly believes IRs have a current and growing role in the care of patients with ischemic strokes,” said SIR President M. Victoria Marx, MD, FSIR, an interventional radiologist at Keck Medicine of USC. “We stand committed to advocate for policy changes and provide the cognitive and technical skills and resources necessary for IRs to provide high-quality care.”
Stroke affects 16.9 million worldwide each year, with 795,000 new cases in the United States annually. Approximately 100,000 of the U.S. cases are eligible for EVT treatment, yet only a fraction are treated due to the shortage of thrombectomy-capable stroke centers. To meet that volume the U.S. would need 500 endovascular stroke centers and 2,000 physicians. It currently has 231 thrombectomy-capable stroke centers.
The global position statement was published on the website of the Journal of Vascular and Interventional Radiology (JVIR) and will appear in its December issue.