A call for neurologists to take up stroke intervention (original) (raw)
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Neuroradiology, 2016
Vascular neurology and Neurocritical care expertise. 4 Neurosurgery expertise, including vascular neurosurgery 5 All relevant neuroimaging modalities (CT/CTA, MR/MRA, Trans-cranial Doppler [TCD]), including 24/7 access to CT and MRI. Summary We, as a group of international multidisciplinary NeuroInterventional societies involved in the endovascular management of acute ischemic stroke, have put forth these training guidelines. We believe that a neuroscience background, dedicated neurointerventional training, and stringent peer review and quality assurance processes are critical to ensuring the best possible patient outcomes. Well-trained neurointerventionalists are a critical component of an organized and efficient team needed to deliver clinically effective mechanical thrombectomy for acute ischemic stroke patients.
Modern Training and Credentialing in Neuroendovascular Acute Ischemic Stroke Therapy
Neurosurgery, 2019
BACKGROUND: Acute ischemic stroke (AIS) remains a significant source of morbidity and mortality worldwide. Multiple recent randomized clinical trials for AIS patients presenting with large vessel occlusion have demonstrated radical improvement in outcomes with mechanical thrombectomy (MT), which is now recognized as the new standard of care for patients presenting up to 24 hr. OBJECTIVE: To provide a perspective on training and credentialing requirements for practitioners in this field. METHODS: Relevant articles were systematically searched and analyzed. Standards for Reporting Qualitative Research guidelines were utilized. RESULTS : The Committee for Advanced Subspecialty Training (CAST) brings together the principal specialties of Radiology, Neurology, and Neurosurgery. Their training standards document the most recent consensus on training for neuroendovascular surgery (NES) and include the endovascular treatment of AIS as a part of the field of NES. This unified consensus represents a significant landmark in the evolution of stroke therapy. Presently, training at most centers follows an apprenticeship type model. Simulation methods and objective performance metrics have not been widely incorporated. Maintenance of proficiency has not been conclusively addressed reflecting the overall developing nature of the field. CONCLUSION : The evolution of the standard of care interventional therapy for large vessel AIS utilizing MT raises concerns regarding work force needs, training standards, competency, and credentialing requirements for practitioners. The CAST framework represents the most modern and flexible approach for both individuals and training programs. Methods based on objective performance metrics utilizing simulation as primary vehicle may be the logical next steps in the evolution of NES.
Advances in Interventional Cardiology
Stroke, a vascular disease of the brain, is the #1 cause of disability and a major cause of death worldwide. Stroke has a major negative impact on the life of stroke-affected individuals, their families and the society. A significant proportion of stroke victims indicate that would have preferred death over their after-stroke quality of life. Mechanical thrombectomy (MT), opening the occluded artery using mechanical aspiration or a thrombus-entrapment device, is a guideline-mandated (class I, level of evidence A) treatment modality in patients with large vessel occlusion stroke. MT clinical benefit magnitude indicates that a universal access to this treatment strategy should be the standard of care. Today there is a substantial geographic variation in MT deliverability, with large-scale disparities in MT implementation. In many countries effective access to MT remains severely limited. In addition, many of the MT-treated Advances in Interventional Cardiology 2021; 17, 3 (65) patients are treated too late for a good functional outcome because of logistic delays that include transportations to remotely located, scarce, comprehensive stroke centres. Position Paper from the European Society of Cardiology Council on Stroke and European Association for Percutaneous Cardiovascular Interventions on interdisciplinary management of acute ischaemic stroke, developed with the support of the European Board of Neurointervention fills an important gap in systematically enabling interventional cardiologists to support stroke intervention in the geographic areas of unmet needs in particular. We review strengths and weaknesses of the document, and suggest directions for the next steps that are swiftly needed to deliver MT to stroke patients more effectively.
Frontiers in Surgery, 2021
The incidence of stroke has seen over a 100% rise in low- and middle-income countries (LMICs), from 1970-1979 to 2000-2008, while it has stayed nearly the same or decreased in several high-income countries (HICs). However, it has been primarily in HICs that endovascular neurosurgery has evolved to become the standard of care in the management of stroke along with becoming a key modality for managing aneurysms, vascular malformations, carotid artery disease, amongst others. With 30 million individuals suffering from the aforementioned conditions and 7.3% of overall deaths due to stroke alone, India has a particularly high disease burden that can be tackled by neurointerventional therapies. Despite stroke being a leading cause of death and a public health priority in LMICs like India, provision of endovascular neurosurgical care is extremely scarce, both in its infrastructure and the number of trained subspecialist practitioners. This opinion piece utilizes the case scenario of India to highlight how the disparity of endovascular neurosurgical care exists in the face of excellent training and delivery of general neurosurgery and its other subspecialties and highlights key recommendations. One major reason, which this article focuses upon, is the near complete lack of accredited subspecialty training in endovascular care for neurosurgeons in India in 2021. Given that the majority of neurosurgery fellowships in India are currently non-accredited in nature, professional neurosurgical societies in LMICs will play a key role in supporting fellowship accrediting bodies. With the absolute dearth of dedicated neuroendovascular training during neurosurgery residency in developing countries, coupled with the unique and specific needs of this subspeciality, it will be the establishment of high-quality, accredited fellowships that would be crucial for having the framework for delivering endovascular care.
Introduction: Acute ischemic stroke, a subtype of acute stroke is one of the leading causes of death and major cause of morbidity and mortality throughout the world. The incidence of acute ischemic stroke is increasing with gradual increase in obesity, diabetes mellitus, hyperlipidemia, hypertension and some other cardiac problem. Objective: The study has been conducted with a primary objective to study the epidemiology and clinical presentation of acute ischemic stroke. Methods: This cross sectional study was carried out among 100 acute ischemic stroke patients(clinically and radiologically confirmed) irrespective of age and sex admitted to Medicine and Emergency Department of Regional Institute of Medical Sciences(RIMS), Imphal after getting clearance from Institutional Ethical Committee(IEC). The acute ischemic stroke patients were also undergone plane CT (computed tomography) scan brain by the CT scan model Philips Brilliance 64 slice CT for radiological confirmation and to localize the lesion in brain. Data, collected in prescribed protocol, were analyzed in simple statistical percentage. Result: Acute ischemic stroke was found most commonly in 50-75 age group with male predominance. Majority of the acute stroke patients were smoker, non-vegetarian and hypertensive. The commonest clinical feature at presentation was hemiplegia. Rightsided hemiplegia was the predominant finding in acute stroke patients. Left hemisphere brain infarction was more common than right hemisphere lesion in brain. Conclusion: In this study, the epidemiology, clinical presentation and various risk factors of acute ischemic stroke have been focused, by targeting which the burden of this disabling disease can be prevented.
Stroke Treatment Academic Industry Roundtable
Stroke, 2013
Background and Purpose-The goal of the Stroke Treatment Academic Industry Roundtable (STAIR) meetings is to advance the development of stroke therapies. At STAIR VIII, consensus recommendations were developed for clinical trial strategies to demonstrate the benefit of endovascular reperfusion therapies for acute ischemic stroke. Summary of Review-Prospects for success with forthcoming endovascular trials are robust, because new neurothrombectomy devices have superior reperfusion efficacy compared with earlier-generation interventions. Specific recommendations are provided for trial designs in 3 populations: (1) patients undergoing intravenous fibrinolysis, (2) early patients ineligible for or having failed intravenous fibrinolysis, and (3) wake-up and other late-presenting patients. Among intravenous fibrinolysis-eligible patients, key principles are that CT or MRI confirmation of target arterial occlusions should precede randomization; endovascular intervention should be pursued with the greatest rapidity possible; and combined intravenous and neurothrombectomy therapy is more promising than neurothrombectomy alone. Among patients ineligible for or having failed intravenous fibrinolysis, scientific equipoise was affirmed and the need to randomize all eligible patients emphasized. Vessel imaging to confirm occlusion is mandatory, and infarct core and penumbral imaging is desirable in later time windows. Additional STAIR VIII recommendations include approaches to test multiple devices in a single trial, utility weighting of disability end points, and adaptive designs to delineate time and tissue injury thresholds at which benefits from intervention no longer accrue. Conclusions-Endovascular research priorities in acute ischemic stroke are to perform trials testing new, highly effective neurothrombectomy devices rapidly deployed in patients confirmed to have target vessel occlusions. (Stroke. 2013;44:3596-3601.
Introduction: Acute ischemic stroke, a subtype of acute stroke is one of the leading causes of death and major cause of morbidity and mortality throughout the world. The incidence of acute ischemic stroke is increasing with gradual increase in obesity, diabetes mellitus, hyperlipidemia, hypertension and some other cardiac problem. Objective: The study has been conducted with a primary objective to study the epidemiology and clinical presentation of acute ischemic stroke. Methods: This cross sectional study was carried out among 100 acute ischemic stroke patients(clinically and radiologically confirmed) irrespective of age and sex admitted to Medicine and Emergency Department of Regional Institute of Medical Sciences(RIMS), Imphal after getting clearance from Institutional Ethical Committee(IEC). The acute ischemic stroke patients were also undergone plane CT (computed tomography) scan brain by the CT scan model Philips Brilliance 64 slice CT for radiological confirmation and to localize the lesion in brain. Data, collected in prescribed protocol, were analyzed in simple statistical percentage. Result: Acute ischemic stroke was found most commonly in 50-75 age group with male predominance. Majority of the acute stroke patients were smoker, non-vegetarian and hypertensive. The commonest clinical feature at presentation was hemiplegia. Rightsided hemiplegia was the predominant finding in acute stroke patients. Left hemisphere brain infarction was more common than right hemisphere lesion in brain. Conclusion: In this study, the epidemiology, clinical presentation and various risk factors of acute ischemic stroke have been focused, by targeting which the burden of this disabling disease can be prevented.