A new analysis comparing the outcomes for more than 1,000 stroke patients treated by interventional radiologists (IR) or neurointerventional (NI) physicians found equivalent results among patients treated by either specialty.
The findings, published in the June issue of the Journal of Vascular and Interventional Radiology, confirm that appropriately trained interventional radiologists safely and effectively deliver endovascular thrombectomy (EVT), which is standard of care for large vessel acute ischemic stroke. Multiple randomized trials have proven that intervention with EVT increases patient survival rates and results in fewer disabilities and greater functional recovery than other treatments.
“When it comes to stroke, ‘time is brain,’ but unfortunately the ability for Americans to access comprehensive stroke centers capable of providing life- and function-saving EVT remains stymied by geography and a shortage of NI specialists,” David Sacks, MD, FSIR, an interventional radiologist at Reading Hospital/Tower Health in West Reading, Pa., and the lead author of the paper. “Given the lifesaving effects of EVT, it is critical that we create new cohorts of trained physicians who can provide this care.”
“Because IRs have training and knowledge of the vascular system and neuroimaging, they are ideal candidates to receive the additional training necessary to effectively fill this crucial care role,” Sacks said. “IRs are also clinicians, trained to provide pre- and post-procedural care to patients and to work as a team with neurologists, neurointerventionalists, nursing staff and rehabilitation staff.”
Study authors reviewed data from 1,009 patients treated by interventional radiologists (622 patients) or neurointerventional physicians (387 patients) in eight hospitals that used both IR and NI physicians to provide endovascular stroke care. Their analysis found “no significant differences between specialties” in terms of procedure duration, successful revascularization, or clinical outcomes, such as the patients’ return to independence.
“With these latest data showing that IR-performed EVT offers patients outcomes equivalent to neurointerventional specialists, we look to collaborate with other societies and industry partners to increase training opportunities and access to this critical treatment option,” said SIR President Matthew S. Johnson, MD, FSIR, an interventional radiologist and professor of radiology and surgery at the Indiana University School of Medicine in Indianapolis. “In this way, we can begin to create oases of EVT-capable stroke centers in current care deserts, saving thousands of lives each year.”
“To that end, SIR is working with IR residency programs to develop neurointerventional training pathways so that IRs entering practice have the opportunity to offer stroke care and, with additional formal training, potentially the full spectrum of neurointerventional care,” Johnson said.
According to the Centers for Disease Control and Prevention, stroke affects approximately 795,000 Americans each year. Of those cases, approximately 100,000 may be eligible for EVT treatment, yet only a fraction are treated due to lack of access to NI physicians and a shortage of EVT-capable stroke centers. To meet that volume the U.S. would need 500 thrombectomy-capable stroke centers and 2,000 physicians. It currently has 306 comprehensive and thrombectomy-capable stroke centers, primarily located in major cities.
Read the full study on jvir.org, where you can also access multi-society positions statements and multi-specialty training guidelines about EVT stroke care.