Neuro Endovascular

[deleted300432]

Would appreciate as many two-cents as I can get on the following:

My final goal is to complete a NeuroEndovascular fellowship. I'm a Neurologist; now doing a NeuroICU fellowship; considering to enter a NeuroEndovascular fellowship next.

Personal reasons prevented me from considering a Neurosurgery residency before. Did not enter the Endovascular path through Radiology 'coz I don't like non-Neuro Rad.

Right now I'm seriously considering to apply to a NSG residency (I'm not suggesting I'm gonna get a spot for sure, but I think I'm strong enough of a candidate). Questions are:

1-How much Endovascular most NSG/Endo folks do actually practice? (if it's close to 100%, then I see not point in entering a NSG residency and I'd just do it right now)

2-How much Endovasc are current NSG residents actually getting? Are there newly formed NSG out there performing Endovasc procs with no fellowship training needed?

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[phenylacetone]

Where are you doing neuro-ICU that you aren't familiar with endovascular neurosurgery's scope of practice?

 

[deleted300432]

Where are you doing neuro-ICU that you aren't familiar with endovascular neurosurgery's scope of practice?

A smart med student like yourself probably knows already that practices change drastically based on geography.

In my hospital system neuroendovascular is completely managed by Neurologists. These folks divide their time between angio suite, stroke unit, neuroICU and sometimes basic science benches.

My question is what's the scope of neuroendovascular for a neuroSURGEON, and how this changes between an academic center and a community hospital/group.

(I prefer answers from higher levels than med students).

 

[phenylacetone]

At my hospital, the neuroendovascular service is split between a neurosurgeon who does >80% endovascular and a interventional neurologist.

My cursory research on neurosurgery residencies suggest that dedicated endovascular rotations amount to 3-6 months total if they exist at all.

Sorry if my credentials aren't enough to answer this fairly basic question that has nothing to do with credentials.

 

[gonogo]

Would appreciate as many two-cents as I can get on the following:

My final goal is to complete a NeuroEndovascular fellowship. I'm a Neurologist; now doing a NeuroICU fellowship; considering to enter a NeuroEndovascular fellowship next.

Personal reasons prevented me from considering a Neurosurgery residency before. Did not enter the Endovascular path through Radiology 'coz I don't like non-Neuro Rad.

Right now I'm seriously considering to apply to a NSG residency (I'm not suggesting I'm gonna get a spot for sure, but I think I'm strong enough of a candidate). Questions are:

1-How much Endovascular most NSG/Endo folks do actually practice? (if it's close to 100%, then I see not point in entering a NSG residency and I'd just do it right now)

2-How much Endovasc are current NSG residents actually getting? Are there newly formed NSG out there performing Endovasc procs with no fellowship training needed?

At my hospital, the two neurosurgeons who do endovascular do it 100% of the time. The amount of endovascular you get in neurosurgery residency will depend on each residency. I think most neurosurgeons will go through a dedicated endovascular fellowship before becoming independent interventionalists.

Keep in mind that open surgeries have nothing to do with endovascular. You need to learn tons of things about catheters, coils, etc... which ones exactly to use for each procedure... how to manipulate the catheter, how to understand the 3D imaging behind each approach... those skills take time and practice to develop, no matter from which background you're coming.

 

[gonogo]

In my hospital system neuroendovascular is completely managed by Neurologists. These folks divide their time between angio suite, stroke unit, neuroICU and sometimes basic science benches.

I'm really surprised they can actually do all that stuff at the same time. Many endovascular procedures are very long. Most hospitals have no more than 2-3 interventionalists so usually these guys are doing procedures all the time. Is volume at your hospital not too high? How many procedures a day do they do? How many diagnostics vs therapeutic ones? Just curious.

 

[deleted300432]

I'm really surprised they can actually do all that stuff at the same time. Many endovascular procedures are very long. Most hospitals have no more than 2-3 interventionalists so usually these guys are doing procedures all the time. Is volume at your hospital not too high? How many procedures a day do they do? How many diagnostics vs therapeutic ones? Just curious.

Where I did residency, not that many as there are not many outside referrals; just a handful per week. There's two of them, one works full time in one hospital doing angio and non-angio Neuro; the other one only does angio in other community hospitals.

Where I'm now, it seems like those folks spend the whole day in the suite.

Given those two different scenarios I'm curious to know what's the most common model I should expect once I'm ready to practice.

 

[kitsunepixie]

At my program, Endovascular is done by our 4 very busy neurointerventionalists. Residents can do an infolded endovasc/open vasc fellowship where they get first dibs on any vascular entity that comes in and it's very popular. We get a ton of aneurysms where I'm at and there's certainly no lack of experience. I have no idea about for Neurology trained physicians though since I've never met one.

 

[deleted300432]

At my program, Endovascular is done by our 4 very busy neurointerventionalists. Residents can do an infolded endovasc/open vasc fellowship where they get first dibs on any vascular entity that comes in and it's very popular. We get a ton of aneurysms where I'm at and there's certainly no lack of experience. I have no idea about for Neurology trained physicians though since I've never met one.

How does the infolded endovasc fellowship extends the residency for those who do it?

 

[gonogo]

Given those two different scenarios I'm curious to know what's the most common model I should expect once I'm ready to practice.

Each practice will vary depending on each setting. For example, in private practice, where a lot of endovascular is done by NIR-trained neuroradiologists, they usually divide their time between reading diagnostic neuro studies and performing procedures. Granted, most of these private practices don't get the more complex cases. In academic settings, most NIR guys will be doing NIR 100% of their time.... with probably some protected time for research depending on the institution.

 

[Core Dome Ahhh]

How does the infolded endovasc fellowship extends the residency for those who do it?

Where I'm at all in folded fellowships, including endovascular, do not extend the residency at all. You can take dedicated research time or you can do an in folded fellowship, either way it's 7yrs.