SIR/CIRSE/IRSA recommending stroke training for interventional radiologists
The Society of Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE), and the Interventional Radiology Society of Australasia (IRSA) have published a global position statement committing to to training interventional radiologists in the treatment of stroke victims. The international initiative is being undertaken to alleviate the shortage of physicians trained in endovascular stroke therapies.
An estimated 16.9 million patients have a new stroke each year. In the United States alone, there are an estimated 795,000 new stroke victims, the majority (87%) of whom have an ischemic stroke, a stroke that occurs as a result of obstruction within a blood vessel supplying blood to the brain.
EVT, or clot removal, is the standard of care for patients suffering acute ischemic stroke caused by blocked arteries. EVT is proven to save lives and improve outcomes for patients suffering acute ischemic strokes. With the treatment, these stroke victims have a better chance of improved outcomes, of developing fewer stroke-related disabilities, and of survival.
There is a shortage of physicians and comprehensive stroke centers providing endovascular thrombectomy (EVT) throughout the world. 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, according to SIR. The United States currently has 231 such centers, but to treat 100,000 patients, SIR estimates that an additional 500 endovascular stroke centers and an additional 2,000 trained physicians are needed.
The three societies endorse EVT being provided “as part of the services of a rigorous, structured, multispecialty care team including vascular neurologists”, but state that “appropriately trained interventional radiologists can evaluate stroke patients and provide emergent ETV with good outcomes.” The societies state that neurointerventional skills used by interventional radiologists to perform EVT are not intended to perform specific neurointerventional procedures such as cerebral aneurysm occlusion and cerebral embolization. However, “appropriately trained interventional radiologists can provide care, especially when neurointerventional physicians are not available, and can help provide 24-hour, 7-day care working in partnership with neuro-interventional physicians when they are available.”
SIR is already revising its current stroke training guidelines to support expanded patient access to interventional stroke treatment. The training will include clinical neurology and care of the stroke patient, stroke imaging, and performance of EVT. The training will reinforce Joint Commission and American Heart Association (AHA) requirements for physicians operating in Thrombectomy-capable Stroke Centers (TSCs) and Comprehensive Stroke Centers (CSCs).
REFERENCE
- Sacks D, van Overhagen H, van Zwam WH, et al. The role of interventional radiologists in acute ischemic stroke interventions: A joint position statement from the Society of Society of Interventional Radiology, the Cardiovascular and Interventional Radiology Society of Europe, and the Interventional Radiology Society of Australasia. J Vasc Interv Radiol. Published online October 28, 2018. doi: 10.1016/j.jvir.2018.09.035.