Neuroendovascular

[MedStudent221]

I'm a 3rd year med student and am interested in doing neuroendovascular. I have pretty solid scores and some neuro research and some other various papers I did. What would the best path be for me, given that I'll be a US grad? Would it be worth trying to match at the top programs for neuro? Or should I go with radiology? I am not really all that interested in radiology (but I'm sure that once I try it, I'll like it), and I'm not intersted in pursuing neurosurg. Any words of wisdom/advice? 🙂
Thanks!!

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[ChildNeuro]

I'm a 3rd year med student and am interested in doing neuroendovascular. I have pretty solid scores and some neuro research and some other various papers I did. What would the best path be for me, given that I'll be a US grad? Would it be worth trying to match at the top programs for neuro? Or should I go with radiology? I am not really all that interested in radiology (but I'm sure that once I try it, I'll like it), and I'm not intersted in pursuing neurosurg. Any words of wisdom/advice? 🙂
Thanks!!

What specifically do you want to do with neuroendovascular? If you want to be the one actually doing the procedure then I would recommend applying for a radiology residency and then doing the interventional fellowship. I don't know a whole lot about the field, but it seems that an interventional neurology fellowship post-neurology is just in it infancy. There are also triple board residencies i.e. neurology,radiology,and neuroradiology all in one residency.

 

[MedStudent221]

Really? What institutions offer "triple" residencies or neuroradiology programs? I have never heard of them. All of the neuroendovascular ppl at my institution seem to have either gotten there via radiology or neuro and did subsequent fellowships. Thanks sooo much. I appreciate the help!😳

 

[llogg]

Have you done a forum search yet? There have been several great threads on this subject in the past year.

 

[Bonobo]

I am not sure, but I believe that Johns Hopkins and New York University have such "triple" residency training. The programs actually combine neurology and radiology and neuroradiology into one 7-year program that requires 1 additional year for interventional. Without such a program, it would take 9-10 years to complete all that training, which might still be difficult to do anyway.

The years seem long (8-10), but the extra 1-2 years might be worth it when looking for jobs and having to compete with those trained only via neurology or radiology. It probably would make one in as good of position for the field as someone who trains via neurosurgery given the combination of developing technical/procedural skills via radiology and clinical skills via neurology. And it is about the same amount of time as for neurosurgery-based interventional program (typically 9 years). So being able to do it all in 8 years is a steal...

B

 

[neurosign]

There are discussions about the pathway to neuroendovascular training (also known by many other names) elsewhere in this forum. Briefly, I would suggest that, after having gone through similar dilemma when I was in med school, I decided to apply for neurology as a segway to interventional neuro. If you are interested in the rest of radiology (besides the neuro aspect) then pursue interventional via rads. The neuro part makes up a tenth of radiology. If you are interested in neurology, then aim for top neuro residency programs which will increase your chances for getting into a neurointerventional fellowship. This is important because, as others have mentioned, the field via the neurology pathway is still young and will become more competetive by the time you are ready to apply for fellowships. Therefore you want to ensure you will get into one of these spots by training at a neurology residency with a strong stroke program whose faculty are well known and will provide you with the recommendation letters for neurointerventional fellowships and, moreover, provide you with plenty of opportunities to do research while in training. Here are a list of programs I would recommend, based on my background research on them, their track record for sending residents into neurointerventional fellowships, and if they already have their own neurointerventional program, preferably via neurology or if they've traditionally accepted neurologists along with radiologists:

MGH
UCLA
Cleveland Clinic
Minnesota
UMDNJ-Newark
Columbia
Pittsburgh
NYU
Cornell
Barrow
Emory

This is just a short list to give you an idea that the field is moving the right direction, with great opportunities for neurologists. You can check out the SVIN (Society for Vascular and Interventional Neurology) website at:

http://www.svin.org for a list of current fellowships in neurointerventional, mostlly run by neurology programs. This list will be expanded over time to include the programs I listed above and many more, if they're already not on the list. You can PM me if you have more questions. Thanks.

 

[neurologist]

I'm a 3rd year med student and am interested in doing neuroendovascular. I have pretty solid scores and some neuro research and some other various papers I did. What would the best path be for me, given that I'll be a US grad? Would it be worth trying to match at the top programs for neuro? Or should I go with radiology? I am not really all that interested in radiology (but I'm sure that once I try it, I'll like it), and I'm not intersted in pursuing neurosurg. Any words of wisdom/advice? 🙂
Thanks!!

3 best paths to "neuroendovascular":

!. Radiology
2. Radiology
3. Radiology

While there are neurologists who do end up as catheter-drivers, a) it is often a long convoluted route (neuro residency, then stroke/cerebrovascular fellowship, then maybe critical care fellowship, then maybe finally endovascular fellowship . . . and b) once they get there, they are catheter-drivers, not clinical neurologists. If you are an "endovascularist" you spend your days doing endovascular procedures, not evaluating and following patients from the time they hit the ER to the time they leave the hospital.

Best path for the foreseeable future is still rads residency with interventional neuro-rads fellowship.

 

[neurosign]

The path to neuroendovascular in terms of length is the same, regardless of training in neurology or radiology.

From Neurology:
Prelim med 1yr + neuro res 3yrs + stroke fellowship 1yr OR neurocritical care 2yrs + interventional 2yrs = 7-8 yrs

From radiology:
Prelim med 1yr + rads 4 yrs + neurorads fellowship 1yr + interventional 1-2yrs = 7-8yrs

You can either do vascular neurology OR neuro-critical care prior to interventional training from a neurology route. There are advantages on each side and in terms of duration, vascular neuro is only 1yr, while critical care is 2yrs. And for neurologists, the neurorads training is built into the interventional training so they do not have to apply for separate fellowships unlike radiologists.

A few years ago, the ACGME approved the guidelines for training in neurointerventional through neurology, in addition to radiology & neurosurgery. Since then, the number of stroke fellowship programs have grown considerably because one of the goals for expansion of vascular neurology has been to serve as a pathway to neurointerventional training, as it is a prerequisite for those applying to interventional programs from a neurology background.

Dr. Walter Koroshetz (one of the leading stroke neurologists in the country), in his talk at the recent inaugural SVIN meeting in Boston, mentioned this as one of the main factors for establishment of vascular neurology fellowships...to provide a training pathway that would bridge neurology residencies to neurointerventional fellowships.

For anyone primarily interested in neurology/stroke, with thoughts of doing interventional neurology, I would encourage you to pursue it through a neurology residency. Finally, the neurointerventional field is not just catheter-based procedures, as these specialists apply their neurology knowledge in both pre- and post-procedure workup and routine followup with clinic at least 1-2x per week.

 

[ChildNeuro]

3 best paths to "neuroendovascular":

!. Radiology
2. Radiology
3. Radiology

While there are neurologists who do end up as catheter-drivers, a) it is often a long convoluted route (neuro residency, then stroke/cerebrovascular fellowship, then maybe critical care fellowship, then maybe finally endovascular fellowship . . . and b) once they get there, they are catheter-drivers, not clinical neurologists. If you are an "endovascularist" you spend your days doing endovascular procedures, not evaluating and following patients from the time they hit the ER to the time they leave the hospital.

Best path for the foreseeable future is still rads residency with interventional neuro-rads fellowship.

I think that radiologists would have an advantage in being a better neuroradiologists, because possibly they enjoy/develope better 3-Dimensional skills i.e. trying to imagine the 3-D lay from serial 2-D CT scan cuts. Also, I would guess that as a radiology resident you could get to see a fair amount of interventional procedures, maybe even help assist, so you are already in the mindset to do the procedure. For those who want to focus solely on the procedural part of the care, then I suppose that they would be in a group with neurologists who could evaluate the patient in clinic as need be. I don't know the exact numbers, but I think that the majority of residents entering the "neuroendovascular" fellowship came from radiology. I would go either radiology or the triple boards if I wanted to do that, because, after years of seeing patients on the wards and in ICU, you haven't been thinking 3-D anatomy for awhile like radiologists do on a daily basis. The vast majority of neurology residencies don't prepare you for interventional radiology, which is really what this is.

 

[Imhotep]

Johns Hopkins does not offer the combined neuro/rad/neurorad training pathway anymore.

 

[danielmd06]

The combined programs should be listed on FRIEDA. I'm pretty sure Hopkins was removed from the list.

 

[hans19]

I'm a 3rd year med student and am interested in doing neuroendovascular. I have pretty solid scores and some neuro research and some other various papers I did. What would the best path be for me, given that I'll be a US grad? Would it be worth trying to match at the top programs for neuro? Or should I go with radiology? I am not really all that interested in radiology (but I'm sure that once I try it, I'll like it), and I'm not intersted in pursuing neurosurg. Any words of wisdom/advice? 🙂
Thanks!!

All three mentioned fields can lead to interventional neuroradiology/ESN. Of the 3, the most developed, 'mature' track is through radiology. The majority of interventional neuroradiologists practicing today come from a radiology background, with an increasing minority from neurosurgery. The fewest come from neurology backgrounds. Again, you can come from any field but in terms of hospital credentialling for procedures, access to angio suites, you will be at a severe disadvantage coming from neurology.

Here's why-- if you go to any hospital with a radiologist department (virtually all hospitals), what radiology group is going to let you use their angiography suite (which they have bought) to do procedures (that they would normally do)? None! Not only that, the hosital administration has usually contracted with a radiology group to provide neurointerventional services as part of the package. But lets say you get past the bureaucratic administrative red tape, and the hospital allows you to provide INR services. Basically you will have to come up with a 700 to 1 million cash to buy your angio suite, plus the cash to lease the space, plus cash to hire your angio techs plus a radiation physicist to help you with quality control. Again, why would the hospital pay for you to have an angio suite, when radiology already has an angio suite? Basically you will have to come up with the capital yourself. On that alone, radiology or neurosurgery is at a political/economical advantage over neurology in most hospitals.

Anyways, if you are dead set on INR, than consider an integrated program such as the one offered by P. Kim Nelson at NYU (neurology/radiology/NR/INR), but these are few and far between.

As far as neurologists doing INR, at Southwestern, Glen Pride, the Director of INR did a neurology residency, but also completed a radiology residency and then a neurorads then INR fellowship.

If your scores are solid, you should have no problem getting into a decent rads program and practically waltz into an INR program. Unfortunately for neurologists, they face many obstacles and really have to prove themselves to be taken seriously by INR fellowships (the vast majority of fellowships are run by radiology). That is reality. The Chief neurology resident (brilliant guy) at my institution also wanted to do INR, and he and I considered a lot of the same places, but he had a tough time getting any attention from a lot of fellowship programs. Of course you can try to get into a neurology run program but those programs are few, UMDNJ and UAB, which will be very competitive. Bottom line- INR is a very competitive fellowship for a neurologist to get. Relatively easy for a rads or neurosurgeon to get.

If you aren't already committed to neurology, and you don't want to have to fight a huge uphill battle to do INR, I would seriously consider the radiology route, since you've excluded the neurosurgery route.

What ever your decision, good luck! INR is an incredible field!

 

[werewethere]

What ever your decision, good luck! INR is an incredible field![/quote]
Absolutely Right On!

 

[zarbazan]

*...Bottom line- INR is a very competitive fellowship for a neurologist to get. Relatively easy for a rads or neurosurgeon to get...*

As a neurology resident who recently signed a neurointerventional fellowship offer of his choice after spending several months interviewing, I would like to revive this thread and to disagree with the above statement, realizing that it was made more than a year ago.

First off, every year fewer and fewer radiology residents want to go into interventional neuroradiology, simply because many of them chose this residency exclusively because of lifestyle, which is far from cush for a neurointerventionalist.

Secondly, every year more and more such fellowships open their doors for neurology residents. Some of those (UMN, MCW, UMDNJ) are run by neurologists, others (Pittsburgh, Cleveland Clinic) have prominent interventional neurologists as faculty. I do not know of a single neurology resident in the past two years who really wanted to do an INR/NIR/ESN fellowship and did not get one. Yes, it is competitive, but there's plenty of programs that train neurologists and the list will keep growing as this exciting field becomes more evidence-based. Here are some:

MCW (Zaidat et al)
UMN (Qureshi et al)
Iowa (radiology run but trained only neurologists in the past few years)
Cleveland Clinic (Rishi Gupta)
Pittsburgh (Tudor Jovin)
UMDNJ (Kirwani)
UCLA (the great Vinuela/Duckwiler fellowship program, trained 3-4 neurologists, the last one graduated in July 2008)
Cincinnati
UMASS
UT Houston
UT Southwestern
Miami

BU and SLU are soon to have neurology-run neurointerventional fellowships. Programs like UCSF, Partners, UCSD, Mayo, Emory, Cornell, Columbia have also trained a select few neurologists and this list is by no means complete. I do hope that more and more neurology residents consider becoming neurointerventionalists as INR is indeed (IMHO) an incredibly exciting field.

 

[minstral]

You arent getting the best advice here.
Th future of neurointervention is with neurology. just follow the publications.
Neuro trained folks are publishing radiologist are not.
If you just want to be a technician by all means go via radiology.
If you want to be a clinician who does intervention go through neurology.
Neuro trained folks see the patient before and after intervention. Radiologist get called in for the procedure and return to their dark room. Once a neurointerventionalist via radiology thats your oNly skill.
Neuro you are a critical care/vascular expert with an outpatient clinic and interventional abilities.

the idea that "radioloist" would be better at the imaging side is just sorta ridiculous, as most neurologist are better at brain imaging than a standard (non-nneuroradiologist) radiologist

 

[darksideone]

You arent getting the best advice here.
Th future of neurointervention is with neurology. just follow the publications.
Neuro trained folks are publishing radiologist are not.
If you just want to be a technician by all means go via radiology.
If you want to be a clinician who does intervention go through neurology.
Neuro trained folks see the patient before and after intervention. Radiologist get called in for the procedure and return to their dark room. Once a neurointerventionalist via radiology thats your oly skill.
Neuro you are a critical care/vascular expert with an outpatient clinic and interventional abilities.

the idea that "radioloist" would be better at the imaging side is just sorta ridiculous, as most neurologist are better at brain imaging than a standard (non-nneuroradiologist) radiologist

Also look at intramural/extramural funding from NINDS and see who they are giving the money too. If you want a hint, it isn't radiologist.

 

[HarveyCushing]

Very interesting topic as has been debated many times here on SDN. However I think if you look objectively at the issue as a whole and as "minstral" mentioned about the research being conducted, most of it is being done the way of neurologists. Previous threads discussing that radiology was the best way into neuroendovascular might have been true then, but I believe the tide is slowly favoring neurologists. That is one purpose for the creation of SVIN. As more and more neurologists go into INR (and less and less radiologists), I think you will see this as a field dominated by neurologists within the next 10yrs or so. Especially if more and more neurology trained INR go into academics. I think you are going to see the same thing that happened with interventional cardiology happen with interventional neurology.

 

[zarbazan]

I think you are going to see the same thing that happened with interventional cardiology happen with interventional neurology.

Which is the ultimate goal - to take back what truly belongs to you 😉

 

[darksideone]

Which is the ultimate goal - to take back what truly belongs to you 😉

I couldn't agree more. I don't think radiology will be in control of this field for much longer.

 

[BrianUM]

I am just a 2nd year med student but i can tell you that the interest in Neuro is growing incredibly at our school and most of it is due to Neurointerventional

i shadowed a Neurointerventionalists (Neurologist) and if I had to pick now, I would do Neuro and then Interventional Neuro...the idea of being a clinician and being able to perform procedures (like cardio) is very appealing

just one question, is the lifestyle of neurointervention closer to interventional cards or neurosurgery? granted both work crazy hrs but neurosurgery lifestyle is insane

 

[minstral]

The lifestyle is more like neurosurgery.
I spent a month with Jawad Kirmani in at UMDNJ- newark NJ.

Hard hard work. long long hours on your feet wearing 35+ lbs of lead. constant call.

 

[zarbazan]

The lifestyle is more like neurosurgery.
I spent a month with Jawad Kirmani in at UMDNJ- newark NJ.

Hard hard work. long long hours on your feet wearing 35+ lbs of lead. constant call.

Yet, it you have enough faculty and fellows, it is quite manageable.

 

[Brainologist6]

Very useful information for someone who is applying to neurology residency and is determined to do interventional. Any of you guys are going to be at the SVIN conference?

 

[zarbazan]

Very useful information for someone who is applying to neurology residency and is determined to do interventional. Any of you guys are going to be at the SVIN conference?

Unfortunately, not this year. My department is paying only for one conference a year (even if you submit case reports) and I am already planning to attend the ASN meeting (American Society of Neuroimaging), International Stroke Conference, and AAN. However, if you are determined to go into neurointerventional, it is a great idea to attend SVIN where you can meet many of the neurology-friendly fellowship program directors and make other useful acquaintances. Another great conference for an aspiring neurointerventionalist is the International Stroke Conference (2009 meeting will be in San Diego).

 

[BrianUM]

what sucks is that I go to school in Miami and would love to go to the meeting...but i have a huge GI test the monday after and need the weekend to study for these monster test...sigh

 

[kapMD/PhD]

Really? What institutions offer "triple" residencies or neuroradiology programs? I have never heard of them. All of the neuroendovascular ppl at my institution seem to have either gotten there via radiology or neuro and did subsequent fellowships. Thanks sooo much. I appreciate the help!😳

No one any more - there used to be about 3 - hopkins and some others, but when i searched Freida a few weeks ago they have all been closed. Good luck!

 

[Amos]

My two cents:

90% of our recent neurointerventional fellows have trained neuro first, then interventional.

Many of the top radiology residents are not interested in neuro IR due to lifestyle issues.

The brain is cool....go neuro.

 

[Brainologist6]

I am currently applying to neurology and I am very iterested in interventional. Here is my two cents after attending SVIN conference, talking to some practice neurointerventionalist (president, vice president of SVIN and etc.)

Is it possible to go to neuro interventional through Neurology? of course.

Less people from radiology are going to this field, as it does not agree with their life style. In the future, Neurosurgery is going to be the main supplier along with Neurology (even though there is some talk that cardiologist might also enter, which I don't think would happen if neurologist become more aggressive).

If you like trauma, back surgery, craniotomy and don't mind long hours in OR and a tough life style, then do a Neurosurgery rotation and go to this field, as it would be easier to enter to this field through this route (a bit more painful though). If you don't like long hours in OR, back surgery, and craniotomy but like stroke and neurocritical care, then go to Neurology. You just have to get involve in a related research and get into a good program where you would have a good reference letter and etc. This field is growing and who knows what the future will bring. There is a talk that every Neurology-stroke chairman will need a Neurointerventionalist in the future.

For those of you who have more experience, please let us know if you agree/disagree.

 

[JeetKuneDo]

Sorry for budging in here and reviving this old thread; I'm just a lowly pre-med curious about neurology. To my knowledge from what I've read in past threads, a neurologist can only read images after an interventional fellowship. Is this right?

 

[medsRus]

To my knowledge from what I've read in past threads, a neurologist can only read images after an interventional fellowship. Is this right?

Please define interventional and you shall have an answer...

 

[JeetKuneDo]

Please define interventional and you shall have an answer...

I guess what I mean is that you need to become an interventional neuroradiologist. Is this required just to read images?

 

[medsRus]

I guess what I mean is that you need to become an interventional neuroradiologist. Is this required just to read images?

Certainly not.

 

[neuroir]

I guess what I mean is that you need to become an interventional neuroradiologist. Is this required just to read images?

You don't have to. You can do a neuroimaging fellowship, pass the UCNS neuroimaging examination and read images. Unless you want to read pelvic MRIs in which case doing a radiology residency would be a better idea.

 

[JeetKuneDo]

Certainly not.

You don't have to. You can do a neuroimaging fellowship, pass the UCNS neuroimaging examination and read images. Unless you want to read pelvic MRIs in which case doing a radiology residency would be a better idea.

Thanks for the info everyone.

 

[medsRus]

You don't have to. You can do a neuroimaging fellowship, pass the UCNS neuroimaging examination and read images. Unless you want to read pelvic MRIs in which case doing a radiology residency would be a better idea.

How common is this? Are those neuro-trained docs making as much as neuro-rads? Thanks!

 

[Terpskins99]

How common is this? Are those neuro-trained docs making as much as neuro-rads? Thanks!

I doubt they make nearly as much. Chances are the neuroradiologists will continue to do the majority of final reads/dictations on imaging reports in the hospital. Also, a neuroradiologist will be able to read other reports (namely ER film) that a neurologists wouldn't (or at least, shouldn't).