Neuro IR after IR?

[MouseChair]

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ESIR resident, applying to IR.

Recently becoming more interested in Neurointervention. What is the path to Neuro IR after Interventional independent Residency? Is it really Neuro Diagnostics and then Neuro IR after that?

 

[Tiger100]

If you want to do only stroke, a good number of IRs in the community are doing stroke thrombectomy. You can learn the skill. However, you will probably face some challenges for credentialing in the future or if you want to work in a big center. But at the level of community hospital you are good to go for the foreseeable future.

If you want to do high end NeuroIR, you have probably wasted a few years which is fine in the grand scheme of things. The standard path is Neuro and then NeuroIR.

You have to choose to do either high end NeuroIR (stroke is an exception here) or body IR. It is hard or impossible to find a job to do both.

 

[account]

This site lists interventional radiology directly to neurointerventional as a legitimate pathway. I am unsure if this is feasible in practice, or if it is newly introduced.

 

[MouseChair]

If you want to do only stroke, a good number of IRs in the community are doing stroke thrombectomy. You can learn the skill. However, you will probably face some challenges for credentialing in the future or if you want to work in a big center. But at the level of community hospital you are good to go for the foreseeable future.

If you want to do high end NeuroIR, you have probably wasted a few years which is fine in the grand scheme of things. The standard path is Neuro and then NeuroIR.

You have to choose to do either high end NeuroIR (stroke is an exception here) or body IR. It is hard or impossible to find a job to do both.

Can you elaborate what it means to practice high end neuro IR?

Does this mean cerebral angiograms? Aneurysm coiling? What makes these particular things more difficult stroke work? Sorry if I am being ignorant.

 

[Tiger100]

Can you elaborate what it means to practice high end neuro IR?

Does this mean cerebral angiograms? Aneurysm coiling? What makes these particular things more difficult stroke work? Sorry if I am being ignorant.

Cerebral angiograms and stroke interventions are bread and butter not because they are easy but mostly their numbers are higher. So a typical community hospital have enough cases for you to do. Anything more than that is usually very low number and you need to be in a referral center to practice it.
Learning is one story. Finding the right practice setting is a different story. It is like being a transplant surgeon. You can not just open your shop and start doing transplants.

 

[ProReduction]

ESIR resident, applying to IR.

Recently becoming more interested in Neurointervention. What is the path to Neuro IR after Interventional independent Residency? Is it really Neuro Diagnostics and then Neuro IR after that?

Neurointensivist and Stroke physician here. Neurointervention has become the worst lifestyle in all of medicine. Being on thrombectomy call in 2023 puts many Neurointerventionists as first-call for any patient presenting with stroke symptoms >4.5 hours from last known well and <24 hours from last known well. I responded to a Stroke alert the other day at a major medical center only to be told "this is a code Neurointervention not a code stroke so we only want the Neurointerventionist to consult". Fine by me. These guys are expected to be up all night doing thrombectomies and not miss a beat on elective aneurysms, AVM, DSAs, etc at 6 AM the next morning. They are rarely paid to be on-call and admin only sees them as having worked if they come in overnight for a thrombectomy. Otherwise the 6-7 calls that keep them up overnight are just unpaid work.

 

[Clean7795]

ESIR resident, applying to IR.

Recently becoming more interested in Neurointervention. What is the path to Neuro IR after Interventional independent Residency? Is it really Neuro Diagnostics and then Neuro IR after that?

Yes that is the standard pathway. There are some programs that will take IR directly.

This is based on tradition, like most things in medicine. Neuroradiology fellowship back in the day implied you had to do at least diagnostic catheter cerebral angiograms.

Does this mean cerebral angiograms? Aneurysm coiling? What makes these particular things more difficult stroke work? Sorry if I am being ignorant.

Elective cases are going to be done in places where people have more experience. Therefore you won't have experience in much except stroke work.