You haven't made any real response to my argument, and I don't think this convinces anyone that body IR is qualified to select acute stroke patients for intervention. It is common experience in neurology that non-neuroradiologists make more errors in diagnostic interpretation which is a significant part of patient selection for stroke intervention. Body IR has even less DR exposure than DR residents. You haven't provided any evidence to support your point, and it is a moot point anyways since body IR has zero ownership in an already crowded turf.
what’s your background? I am not convinced you are familiar with radiology training. And I think we are talking past each other, so let me address your points one by one.
1. Zero ownership in turf: many seminal studies where safety and efficacy of stroke thrombectomy are demonstrated have large amount of those procedures performed by IR, see MRCLEAN. A large amount of stroke interventions are performed by “body IR” which is a misnomer because we are trained to work with the whole body, including the brain. Yes, I do cerebral angiographic work.
2. training required in stroke management: agree that clinical training is required, hence fellowship training should be required, either as a part of the NIR fellowship, or a separate stroke neurology fellowship. I am perfectly fine if radiology trainees are required to do stroke neurology fellowship. You don’t seem to understand that a diagnostic neuro fellowship add very little to the stroke knowledge of a radiologist. It’s like asking a general surgeon to do a cholecystostomy fellowship. At least make our trainees learn something actually useful like clinical mgmt.
3. body IR has less DR exposure: cite sources please? The integrated IR/DR pathway have one less year of elective but those people are still in training. The current frame work is based on the training regiment where Ir and dr have the same amount of diagnostic exposure.
4. error in diagnostic interpretation between neuro vs non-neurotrained radiologists: neuro trained rads have an edge in interpretation of complex MRI, head and neck, and post op/brain tumor imaging, but stroke imaging is literally the bread and butter of radiology. You need to do that to cover the ED. I hate to say it, but if many stroke neurologist deemed themselves savvy enough for patient selection when it comes to stroke imaging, you can’t seriously think that those people have more imaging training than diagnostic radiologists? That’s actually one of the challenge DR face, as many non-radiologists think they can interpret imaging as well as board certified DR, except they can’t.
lastly, I hate to point this out in a forum that isn’t my specialty, but unfortunately there is an overall lack of angiographic proficiency of non-interventional radiologists when it comes to cerebral work. The amount of complications that I’ve heard of or my friends have to fix, and yes, some are from neurologists, are astounding. it’s actually laughable how people who are most proficient by training are relatively excluded from doing what they are trained to do and it’s absolutely a political thing.
Patient selection is the most important thing in stroke thrombectomy, but in my opinion, it’s not the most difficult. The most difficult thing would be to quickly cath that type 3 arch or how to bail yourself out when endovascular complication arises, the actual endovascular neurosurgery part is the most difficult.
