IR in stroke

[IRneuroIR]

There are a lot of ways an interventional radiologist can get involved in stroke care, both from the diagnostic radiology of neuroimaging (even advanced neuroimaging techniques such as perfusion imaging) and also down to the advanced neurointerventions of intra-arterial tPA administration and thrombectomy devices such as Penumbra and Merci. SIR has been promoting IR involvement in stroke care, particularly in the acute setting, and has held successful CLOTS courses over the past two years.

What have you guys heard or seen in terms of IR involvement in stroke?

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[badasshairday]

Do you mean VIR involvment in stroke vs. NIR (which is already all over stroke).?

 

[Gvataken]

Yes, many VIR participate in stroke care. They have the prerequisite neuroimaging background (6 months of neuroimaging). They also have the catheter based techniques for intra-arterial thrombolysis etc. These are the key technical and cognitive components necessary.

Then one should know the trials for acute stroke therapy as well as NIH stroke scale etc and neuro exams.


The CLOTS course sponsored by SIR is a great course to learn more about acute stroke therapy. see below link.

http://www.sirweb.org/meetings/CLOTS.shtml

 

[gonogo]

Yes, many VIR participate in stroke care. They have the prerequisite neuroimaging background (6 months of neuroimaging). They also have the catheter based techniques for intra-arterial thrombolysis etc. These are the key technical and cognitive components necessary.

so how would this work, 6 months neuro fellowship + 1 year IR? I thought most stroke treatment was done by neuroIR.

 

[Gvataken]

During most radiology training you get at least 6 months of neurotraining. The key is the evaluation and interpretation of the imaging. non contrast CT scans, CT angiography, cerebral perfusion studies, MRI and MRA. Then you should also feel comfortable with interpreting conventional cerebral angiography.

Most IR have the catheter skills necessary to do intra-arterial thrombolysis (particularly with microcatheters).

Then finally you should have a solid understanding of the NIH stroke scale and all the trial data out there such as PROACT etc.


The following is a course geared toward IR that are interested in performing stroke work. Many of my IR friends in private practice have or provide stroke therapy.



http://www.sirweb.org/meetings/CLOTS.shtml

 

[NappingGuppy]

so how would this work, 6 months neuro fellowship + 1 year IR? I thought most stroke treatment was done by neuroIR.

At UCSF, all strokes are currently handled by VIR (they go the rads > IR > neuroIR route) and they are very good. My guess is there is variability from institution to institution.

 

[IRneuroIR]

There is definitely variability throughout, but with many more VIR than NIR docs available (and far more than the number of endovascular-trained neurosurgeons and neurologists) and with the requisite imaging knowledge, angiography, and microcatheter skillset, VIR must be a leader in stroke care. It is great to see SIR (with co-sponsorship from the neuroradiology society) conducts courses like CLOTS and increasing the number of lectures/workshops at the annual meeting on the topic of stroke and stroke management. The next step is to try and more formally incorporate stroke training into VIR fellowship so the next line of VIR docs come out ready to tackle this important disease.