Interventional fellowship

[gonogo]

Is there anyone in the forum applying for neurointerventional fellowship this year? Let me know so we can exchange impressions of programs and discuss interview process if you're interested. You can PM me if you want.

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[typhoonegator]

For all the talk about NIR every year, it seems like there isn't really a lot of information exchange on this forum. I don't know if it's because people don't actually follow through, or if they're nervous about writing reviews because it is such a small world and they fear retribution.

I'm more than willing to help post reviews. Please feel free to PM me with any program information and I will post it anonymously.

 

[gonogo]

For all the talk about NIR every year, it seems like there isn't really a lot of information exchange on this forum. I don't know if it's because people don't actually follow through, or if they're nervous about writing reviews because it is such a small world and they fear retribution.

I'm more than willing to help post reviews. Please feel free to PM me with any program information and I will post it anonymously.

Thanks for your post. The anonymous idea is great.

Could you comment on the whole application/interview process? When should we be expecting to hear back from programs? When do programs usually interview? How many candidates for each spot are invited for interview? There's so little information out there. Thanks.

 

[darksideone]

Thanks for your post. The anonymous idea is great.

Could you comment on the whole application/interview process? When should we be expecting to hear back from programs? When do programs usually interview? How many candidates for each spot are invited for interview? There's so little information out there. Thanks.

Typhoon is in NCC and not NIR. He might have some info about his institution but I don't believe he will have much outside of that.

 

[Hellothere111]

Asking for a friend: any updates here? Or an alternate thread?

Found them: thanks!

Bump nonetheless

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[TUGM]

Not applying for intervention this year (probably in the next 1-2 years - this academic year will be NCC match for me). Don't think there are a lot of people on here in the field, and if they are, probably too busy to post.

From talking to fellows, still a very competitive environment for neurologists. Lots of politics in neurosurgery-based departments on training neurologists (meaning you probably won't get a spot - they seem to try and shut us out, reduce training times for themselves (read infolded fellowships), and there is talk of them pushing for separation tactics, meaning that they give us the strokes and they take the rest of the cases). Radiology departments are a bit warmer towards neurologists, but depends on where you are applying. Seems to be a new rise in interest in the field, even amongst radiologists, given positive trials in stroke and the push for minimally invasive therapies.

Still, we do have some people in powerful positions, and programs like UCLA, MCW, UMN, UTSW, Texas Stroke Institute, Iowa, UPMC, NYU, Mt. Sinai, Boston University, U Mass, JFK, UMDNJ, Miami (getting harder to get in), and Miami Vascular continue to recruit neurologists for training.

Some of us love the field and can't imagine doing anything else, but for others, it might not be worth all the politics and attempted throttling from neurosurgery. In all honesty, if neurologists became more aggressive, we could probably take the field for ourselves, but the longer we wait, the more difficult it becomes as it gets saturated by the surgeons and their "technical proficiency"... not sure how doing cranis and spines really prepares you for catheter jockeying.

In my humble opinion, look towards going to a well established, radiology-run department w/ a neurology presence. The radiologists are the experts in catheter work and imaging, and from my experience, are the most proficient at performing these procedures. With a strong knowledge of vascular physiology and neurointensive care, a vascular/NCC neurologist is extremely well poised to be a more complete neurointerventionalist.

 

[Hellothere111]

Thank you!


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[Kazaki]

MS3 genuinely interested in neurointervention, but I'm more leaning towards radiology because as you said,

The radiologists are the experts in catheter work and imaging, and from my experience, are the most proficient at performing these procedures.

I'm not trolling I'm just looking for genuine answers

not sure how doing cranis and spines really prepares you for catheter jockeying

Do you think being in a clinic doing full neuro exams and trying to pinpoint the lesion prepares neurologists to do any kind of interventional work?
I know that when it comes to reading neuro imaging studies it goes radiologist>>>neurosurgeon>>>>>>>>>neurologist. Imaging interpretation skills are mediocre at best and they do no procedures during residency. So the two fundamentals of intervention are missing in the training of a neurologist. So how can neurologists even compete with neuroradiologists and neurosurgeons?

 

[Hellothere111]

MS3 genuinely interested in neurointervention, but I'm more leaning towards radiology because as you said,

I'm not trolling I'm just looking for genuine answers

Do you think being in a clinic doing full neuro exams and trying to pinpoint the lesion prepares neurologists to do any kind of interventional work?
I know that when it comes to reading neuro imaging studies it goes radiologist>>>neurosurgeon>>>>>>>>>neurologist. Imaging interpretation skills are mediocre at best and they do no procedures during residency. So the two fundamentals of intervention are missing in the training of a neurologist. So how can neurologists even compete with neuroradiologists and neurosurgeons?

Wow. Okay, a lot of things to point out here but I'll comment on a couple of them.

I don't know if you have rotated through neurology yet but it's a lot more than doing exams in the clinic and localizing the problem. In an emergent situation, a decent neurological exam can not only diagnose and localize the pathology, but also help you order the correct testing. Moreover, it can also help you interpret the test result (imaging or otherwise), by "clinically correlating". Further, when you follow these patients on the floor or in the icu, a change in exam is what guides you to change your management.
In terms of NIR, unfortunately there's a human being and not just a clot that you are treating. There's no question that radiologists play with catheters more than neurologists do. The etiology, presentation, pharmacological management and prevention are all best taken care of by neurologists. So in that way, it does make sense for a neurologist to be trained in NIR.
Finally, while Neuro radiologists overall read images better than neurologists (with some exceptions as expected), the sequential order of expertise that you have stated is misleading at best. All my stroke attendings have no problems reading and interpreting MRs and CTs, far better than "mediocre" I assure you.

You're more than welcome to pick radiology and that's your choice but you would do well to understand what other services bring to the table.
My two cents.




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[Kazaki]

Wow. Okay, a lot of things to point out here but I'll comment on a couple of them.

I don't know if you have rotated through neurology yet but it's a lot more than doing exams in the clinic and localizing the problem. In an emergent situation, a decent neurological exam can not only diagnose and localize the pathology, but also help you order the correct testing. Moreover, it can also help you interpret the test result (imaging or otherwise), by "clinically correlating". Further, when you follow these patients on the floor or in the icu, a change in exam is what guides you to change your management.
In terms of NIR, unfortunately there's a human being and not just a clot that you are treating. There's no question that radiologists play with catheters more than neurologists do. The etiology, presentation, pharmacological management and prevention are all best taken care of by neurologists. So in that way, it does make sense for a neurologist to be trained in NIR.
Finally, while Neuro radiologists overall read images better than neurologists (with some exceptions as expected), the sequential order of expertise that you have stated is misleading at best. All my stroke attendings have no problems reading and interpreting MRs and CTs, far better than "mediocre" I assure you.

You're more than welcome to pick radiology and that's your choice but you would do well to understand what other services bring to the table.
My two cents.




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the sequential order of expertise that you have stated is misleading at best. All my stroke attendings have no problems reading and interpreting MRs and CTs, far better than "mediocre" I assure you.

Totally disagree with you on that one. If non-rads physicians' skills where not mediocre, radiology as a speciality would cease to exist. Hospital administrators worldwide and organisations like Medicare in Australia or the NHS in England would love it since radiologists are perceived to be overpaid.

Maybe I should've opened with this. I'm an IMG, and pretty soon I've gotta start applying for electives in the states. I don't wanna build a solid neuro application only to realise that radiology would've prepared me better for NIR. And with the combined IR residency taking over by 2020 and IR doctors being given admission privileges, do you think that the option for neurologists to go into a field where they aren't preferred to begin with will disappear? That's my main concern to be honest.

Having said that, I still didn't do my neuro rotation, but I was in the neuro clinic for 3 weeks during basic sciences though so that's what I'm using a reference.
I do understand the importance of different specialities and how they all need to work with one goal in mind, believe me. There's no doubt that you need a neurologist to clinically diagnose a clot in X artery/vein. But after the angio report comes back and it's decided that the patient fits the criteria for intervention, how useful is a neurologist at this point? What if there's an anatomical variant that the neurologist is unfamiliar with? Does the neurologist call rads for a consult? Then what's the point of having the neurologist do the procedure in the first place? I mean you don't need a stroke or vascular neurologist to push tPA, but you do need a **** tonne of skills to coil an aneurysm or retrieve a clot. Skills that a neurologist simply doesn't have. Just like performing and interpreting a full neuro exam is a skill that a radiologist simply doesn't have.
I'm not trying to play-down what neurologists do. But at this point I still don't see how a neurologist can begin to compete with radiologists and neurosurgeons. It just seems like a loosing battle for neurologists at this point because the entire point of interventional procedures is that you have someone that's an expert at reading and interpreting radiological films, and can use that knowledge to treat patients. So far from what I've seen, radiologists smoke any other doctor (no matter the field) at reading films. Duh, it's what they're trained to do. Neurosurgeons spend hours analysing studies and consulting with radiologists before going into an operation, making them quite good at reading films.

Again, I'm not trying to troll or anything. Just want to see what the neurologists have to say about this since I already know what the radiologists think about this entire topic (i.e. no one besides radiologists, especially cards, should do interventions).
And hey if it turns out that neurologists make better interventionalists, it plays out in my favour cause neuro is more IMG friendly than rads

Appreciate any input and sorry for the long post!

 

[Hellothere111]

I have nothing to add. Best of luck with whatever you decide.


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[TUGM]

My point wasn't to state who was "the best" at doing neurointervention. Clearly, radiologists, neurologists, and neurosurgeons all perform interventions successfully. I just happen to think radiologists get the most experience in catheter work during their native training. I would also strongly disagree that neurosurgeons are that much better than neurologists at film reading. It is probably program-dependent, but we also spend "hours" analyzing films while we are diagnosing patients and planning our treatments. In fact, there have been several times where the PGY-3 neurology resident picks up something that the senior radiology resident has missed. Obviously, radiologists are the expert at imaging, but neurointervention is more than just looking at a picture, finding a clot and pulling it out. You are surgically treating patients with extremely sensitive diagnoses. Imagine being told you have an aneurysm that could rupture at any moment - quite a scary thing to hear for a patient. Also do you think securing an aneurysm is the end of aSAH management? Who do you think manages all the stroke and critically-ill neurological patients? (The answer is the neurologist).

Your experience in neurology has been minimal, at best.

As mentioned before, in my humble opinion, a neurovascular- and neurointensive- trained neurologist who has exposure to a strong neuroradiology and neurosurgery department has the opportunity to be a more complete endovascular specialist. Others may differ in opinion, depending on what they assume is the purpose of the neurointerventionalist.

 

[TUGM]

Also the training break down is as follows:

Radiologists: Residency of 4 years, approximately 9 months of neuroradiology during residency, probably less than 1 month of specific neuroangiographical work, 3-6 months of vascular IR (program based) ---> 1 year neuroradiology (diagnostic) fellowship --> 2 years of neurointervention.

Neurosurgeons: Residency of 7 years, approximately 3-6 months of specific neuroangiographic/endovascular work (program dependent) --> 2 years neurointervention (maybe 1 if they do infolded).

Neurologists: Residency of 3 years, approximately 0-3 months of neuroangiographic exposure (program dependent) --> 1 year neurovascular +/- 1-2 years neurocritical care ---> 2 years neurointervention training

The purpose was to show that there is varying degree of exposure to neurointervention specifically in each specialty, but formal training for neurointervention fellowship is becoming relatively standardized for all trainees despite their background specialty. It's how you prepare yourself that really matters.

 

[DrZed]

I'm gonna chime in here. I did a lot of time with interventionalist that were radiologist, neurosurgeons, and neurologist. There are good ones, and there are god-like ones. If you do something enough, you'll get good enough to not kill someone. If you have a natural knack at it, you'll be god-like with that catheter.

As per neurologist not having the skills, I say look at cardiology. They went from being clinical-base to having the option to add in more and more procedures and eventually interventional cardiology was born as well. Again, if you do something enough, you will get good at it.

I've seen interventionalists that can perform the procedure, but damn if I'll let them do it on me. Others, if I ever stroke out, I'd want them to go in, grab the clot, and sign their initials on my MCA with the tip of the catheter.

In order of preference, I'd say neurosurgeons --> Neurologist --> Radiologist. The skills with a catheter are completely unrelated to neurosurgical skills. Neurosurgeons simply because they can convert to open if needed. Neurologist because they will be localizing and following you as soon as the stroke alert is sent out. Radiologist last because they won't see the patient until after they're placed on the table for intervention.

 

[badasshairday]

Not applying for intervention this year (probably in the next 1-2 years - this academic year will be NCC match for me). Don't think there are a lot of people on here in the field, and if they are, probably too busy to post.

From talking to fellows, still a very competitive environment for neurologists. Lots of politics in neurosurgery-based departments on training neurologists (meaning you probably won't get a spot - they seem to try and shut us out, reduce training times for themselves (read infolded fellowships), and there is talk of them pushing for separation tactics, meaning that they give us the strokes and they take the rest of the cases). Radiology departments are a bit warmer towards neurologists, but depends on where you are applying. Seems to be a new rise in interest in the field, even amongst radiologists, given positive trials in stroke and the push for minimally invasive therapies.

Still, we do have some people in powerful positions, and programs like UCLA, MCW, UMN, UTSW, Texas Stroke Institute, Iowa, UPMC, NYU, Mt. Sinai, Boston University, U Mass, JFK, UMDNJ, Miami (getting harder to get in), and Miami Vascular continue to recruit neurologists for training.

Some of us love the field and can't imagine doing anything else, but for others, it might not be worth all the politics and attempted throttling from neurosurgery. In all honesty, if neurologists became more aggressive, we could probably take the field for ourselves, but the longer we wait, the more difficult it becomes as it gets saturated by the surgeons and their "technical proficiency"... not sure how doing cranis and spines really prepares you for catheter jockeying.

In my humble opinion, look towards going to a well established, radiology-run department w/ a neurology presence. The radiologists are the experts in catheter work and imaging, and from my experience, are the most proficient at performing these procedures. With a strong knowledge of vascular physiology and neurointensive care, a vascular/NCC neurologist is extremely well poised to be a more complete neurointerventionalist.

Best post in this thread.

Being a radiologist my opinion is in line with yours. At my program NIR is radiology run with a minor neurosurgical presence so I have done cases with radiology attendings and neurosurgery attendings. I've also double scrubbed with neurosurgical residents. It is clear to me that at least at my institution the radiologists have less complications and are generally more smooth and comfortable in the neuroangiography suite. Also I see clearly that OR skills mean nothing in the Angio lab. At my institution an IR bound resident gets an enormous amount of catheter skills before residency is completed.

Stroke neurology is very important as we work directly with them. They see the patient immediately on presentation and obtain stroke score which can help guide us on borderline cases. They work closely with the diagnostic neuro guys and push tpa as indicated. Generally we see meet the patient in the imaging suite or the Angio suite depending on how fast things move. We do intervention and start drip with recs for blood pressure goals and imaging which our colleagues in the interdisciplinary (neurology run but with presence of neurosurgery residents and the rare radiology resident going into IR) neuroICU appreciate. We usually see the patient as follow up inpatient for the next 2 or so days. I wonder how things work out at other programs, as I feel from my experience being a radiologist that our system works very well. We are definitely more of a clinical neuroIR department and we see follow up and new patients in clinic for the gamut of neurovascular pathologies.

 

[deathmerchant]

Well, in our institution the NIR procedures are mostly done by Neurology trained Interventionists with 20% by one NES trained. They are not done by the Radiology people. They used to do it, but for every acute stroke they(NES and Rads) had to call the Stroke team in as well to make final decision on eligibility, do pre and post management. So what was the point in engaging 2 teams when a stroke- IR person can manage the patient from beginning to end.
The only reason neurology hasn't taken up this field more than they should be is because most people who come to neurology come for a different patient population and career style. Not all of course.

 

[badasshairday]

Well, in our institution the NIR procedures are mostly done by Neurology trained Interventionists with 20% by one NES trained. They are not done by the Radiology people. They used to do it, but for every acute stroke they(NES and Rads) had to call the Stroke team in as well to make final decision on eligibility, do pre and post management. So what was the point in engaging 2 teams when a stroke- IR person can manage the patient from beginning to end.
The only reason neurology hasn't taken up this field more than they should be is because most people who come to neurology come for a different patient population and career style. Not all of course.

Cool. Yes our NIR radiologists are the ones who make the decision whether or not to do endovascular therapy. I am a little confused about post procedure at your institution because an interventionalist is better off spending there time in the angio lab than following the patient to the ICU outside of the acute periprocedural setting. We follow our stroke patients for 2 days usually and give recs to the neuro icu in regards to the acute stroke and intervention. We leave the rest of the stuff (diet, electrolytes, diabetess therapy) to the ICU team because it would not be worth our time to do that as we are so busy in the lab and there are people who dedicate their careers to taking care of patients in the icu.

Stroke neurology is called for the code stroke and the imaging is obviously interpreted by radiology with the decision made by the interventional radiologist. Stroke neuro calls IR if there is a large vessel occlusion otherwise we don't hear about strokes which would be a definite annoyance. Stroke neuro pushes IV tpa if candidate, otherwise the rest of the hyperacute stroke diagnosis and treatment is done by radiology.

 

[deathmerchant]

Cool. Yes our NIR radiologists are the ones who make the decision whether or not to do endovascular therapy. I am a little confused about post procedure at your institution because an interventionalist is better off spending there time in the angio lab than following the patient to the ICU outside of the acute periprocedural setting. We follow our stroke patients for 2 days usually and give recs to the neuro icu in regards to the acute stroke and intervention. We leave the rest of the stuff (diet, electrolytes, diabetess therapy) to the ICU team because it would not be worth our time to do that as we are so busy in the lab and there are people who dedicate their careers to taking care of patients in the icu.

Stroke neurology is called for the code stroke and the imaging is obviously interpreted by radiology with the decision made by the interventional radiologist. Stroke neuro calls IR if there is a large vessel occlusion otherwise we don't hear about strokes which would be a definite annoyance. Stroke neuro pushes IV tpa if candidate, otherwise the rest of the hyperacute stroke diagnosis and treatment is done by radiology.

Thats great that Radiologists are seeing/managing the patients at ur institution. But do u solely manage a stroke patient without having the stroke/NCC team being on board at all?Probably not. If yes, then thats amazing but also extremely rare. Also the fact that Stroke physicians are required to see every patient and fulfill all the Core measures for Stroke certification of the Center. And in our institute the Interventionists are on call 1 week at a time, when they do acutes and electives and in the other weeks they staff the stroke and Neuro ICU and do their elective cases in the mornings.

 

[badasshairday]

Thats great that Radiologists are seeing/managing the patients at ur institution. But do u solely manage a stroke patient without having the stroke/NCC team being on board at all?Probably not. If yes, then thats amazing but also extremely rare. Also the fact that Stroke physicians are required to see every patient and fulfill all the Core measures for Stroke certification of the Center. And in our institute the Interventionists are on call 1 week at a time, when they do acutes and electives and in the other weeks they staff the stroke and Neuro ICU and do their elective cases in the mornings.

You are correct. We have stroke neuro and neuro ICU help. But as you said your neurointerventional guys do a week of purely interventional then a week of stroke/icu. They do not function as stroke neurology or neuro icu during the week of interventional, which makes sense because that would not be efficient to do all 3 at once. Sounds very similar to my medical school. Also sounds similar to my current institution except the neurointerventional guys are on neurointerventional nearly 100% of the time with occasional diagnostic neuro radiology days mixed in.

 

[Nonphysiologic]

While I disagree with Kazaki in the assumption that Neurologists are not as prepared to be interventionalists I do share some of his/her sentiment. I think neurologists can be trained to be excellent interventionalists and I definitely disagree about the neuroimaging comparison. At least in our institution we almost never ever looked or even cared about the radiologist report. The only time we took it seriously is if the report was from one particular neuro radiologist at our hospital who is an OG and one of the smartest neuro radiologists around. But if you want my 2 cents and want to skip the rant thats about to come if you're serious about wanting to do interventional then just go via radiology. That being said, I'm an interventional pain fellow and everyone told me to go via Anesthesiology and or PM&R but I'm the type of person where I cant study something or put my full effort in something if I don't find it interesting so I went via neurology and everything has turned out fine.

I remember during residency (awesome feeling to say that and have residency in the past btw) I would become frustrated with the stroke service because often times the ED is performing a neuroexam, pretty much made up their mind about tpa/intervention or not, calling the interventionalist who is either radiologist or NeuroSx and then they would go to either our stroke unit or neuroICU. I sometimes felt like we as neurology residents were there merely for formality and the decision was pretty much already made or was very obvious. I almost felt our greatest role was to see who had real symptoms and who had non physiologic. I also remember the ED docs were always pushing tPA even if I felt like it was a stroke mimic and didn't require it. Now I know tPA is expensive but the ED docs would always site this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875935/ and decide to push it anyways. And to be frank in regards to imaging it wasn't very complicated....get a vascular study asap if you even slightly suspect a large vessel thrombus at all.

For example: I'd get a page from the ED, NIHSS from ED is like 15 or 20, or its something very obvious like aphasia and right hemiplegia.....without even seeing patient I'd tell the ED to order a CT and CT Angio STAT. I definitely remember a few instances where the ED would just get in touch with the neurointerventionalist and they would take the patient straight to the cath lab to save time and to perform a both diagnostic/therapeutic cath. I really felt useless and frustrated in these situations.

And then to further add to my fustration, I remember when the patients would be up in the stroke unit or downgraded from the NeuroICU we were just planning discharge work essentially and or rehab. Then when I would speak with my PM&R friends at other institutions they would offer all this insight and expertise in regards to post stroke patients.

I think stroke represents how neurologists have let other fields really encroach into our profession and take control. I'm not saying neurologists dont play a key role but I think there are so many players in stroke/interventional that the role of the neurologist has really suffered. I never understood why neurolgists didn't lead the charge in performing the interventional procedures kind like like interventional cardiologists. To be frank it sort of turned me off from pursuing vascular neurology as I increasingly felt like a middleman and just a formality in acute stroke care. Thats why to my junior residents I always encouraged them to pursue a fellowship or skillset that was procedure heavy or unique to neurologists such as EEG, Movement, etc.

Maybe other people's institutions are different but this is what I felt and experienced.

 

[badasshairday]

While I disagree with Kazaki in the assumption that Neurologists are not as prepared to be interventionalists I do share some of his/her sentiment. I think neurologists can be trained to be excellent interventionalists and I definitely disagree about the neuroimaging comparison. At least in our institution we almost never ever looked or even cared about the radiologist report. The only time we took it seriously is if the report was from one particular neuro radiologist at our hospital who is an OG and one of the smartest neuro radiologists around. But if you want my 2 cents and want to skip the rant thats about to come if you're serious about wanting to do interventional then just go via radiology. That being said, I'm an interventional pain fellow and everyone told me to go via Anesthesiology and or PM&R but I'm the type of person where I cant study something or put my full effort in something if I don't find it interesting so I went via neurology and everything has turned out fine.

I remember during residency (awesome feeling to say that and have residency in the past btw) I would become frustrated with the stroke service because often times the ED is performing a neuroexam, pretty much made up their mind about tpa/intervention or not, calling the interventionalist who is either radiologist or NeuroSx and then they would go to either our stroke unit or neuroICU. I sometimes felt like we as neurology residents were there merely for formality and the decision was pretty much already made or was very obvious. I almost felt our greatest role was to see who had real symptoms and who had non physiologic. I also remember the ED docs were always pushing tPA even if I felt like it was a stroke mimic and didn't require it. Now I know tPA is expensive but the ED docs would always site this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875935/ and decide to push it anyways. And to be frank in regards to imaging it wasn't very complicated....get a vascular study asap if you even slightly suspect a large vessel thrombus at all.

For example: I'd get a page from the ED, NIHSS from ED is like 15 or 20, or its something very obvious like aphasia and right hemiplegia.....without even seeing patient I'd tell the ED to order a CT and CT Angio STAT. I definitely remember a few instances where the ED would just get in touch with the neurointerventionalist and they would take the patient straight to the cath lab to save time and to perform a both diagnostic/therapeutic cath. I really felt useless and frustrated in these situations.

And then to further add to my fustration, I remember when the patients would be up in the stroke unit or downgraded from the NeuroICU we were just planning discharge work essentially and or rehab. Then when I would speak with my PM&R friends at other institutions they would offer all this insight and expertise in regards to post stroke patients.

I think stroke represents how neurologists have let other fields really encroach into our profession and take control. I'm not saying neurologists dont play a key role but I think there are so many players in stroke/interventional that the role of the neurologist has really suffered. I never understood why neurolgists didn't lead the charge in performing the interventional procedures kind like like interventional cardiologists. To be frank it sort of turned me off from pursuing vascular neurology as I increasingly felt like a middleman and just a formality in acute stroke care. Thats why to my junior residents I always encouraged them to pursue a fellowship or skillset that was procedure heavy or unique to neurologists such as EEG, Movement, etc.

Maybe other people's institutions are different but this is what I felt and experienced.

This has been my experience with stroke. I think this is why neurology cannot solely take endovascular. That and because neurointerventional is already a multidisciplinary field on which interventionalist in a legit training program learns his deficiencies (ie. Clinical for the radiologists, procedural/imaging for neurosurgeon/neurologist) and they all come out on essentially equal footing.

 

[TUGM]

While I agree with many of the things said above, in my general experience, and taking into account the way the turf battle is playing out, if you are set on doing endovascular, take the neurosurgery route.

I stand by my observation that radiologists have the most proficiency in catheter work, but they do not control patient referrals. Neurosurgeons get the most referrals for these cases - AVMs, aneurysms, AVFs, tumors, etc. Neurologists get referred strokes, stents. I guess you could argue the brunt of the procedures are diagnostic angios - but most referrals for these studies are coming from the surgeon or the neurologist anyway...

 

[neusu]

While I agree with many of the things said above, in my general experience, and taking into account the way the turf battle is playing out, if you are set on doing endovascular, take the neurosurgery route.

I stand by my observation that radiologists have the most proficiency in catheter work, but they do not control patient referrals. Neurosurgeons get the most referrals for these cases - AVMs, aneurysms, AVFs, tumors, etc. Neurologists get referred strokes, stents. I guess you could argue the brunt of the procedures are diagnostic angios - but most referrals for these studies are coming from the surgeon or the neurologist anyway...

I'd have to agree. Not only does the ER often confuse neurology and neurosurgery for hemorrhagic/ischemic stroke consults, if the neurosurgery group is active in interventional they will get the incidental aneurysm/avm/avf eval referrals as well as the sah. It's a small step to take all of the LVO and revascularization as well.