Interventional radiologists without fellowship training remain crucial to stroke care access

Interventional radiologists practicing without fellowship training remain critical to ensuring patients have access to life-saving stroke treatment, according to a new survey.

The Society of Interventional Radiology sent an online survey to active members in February 2019, gaining 536 responses. At least 170 (32%) interventionalists were performing endovascular therapy (EVT) for stroke patients, with 15% having finished a neurointerventional (NI) fellowship, researchers explained Monday in the society’s flagship medical journal.

At the same time, the Society of NeuroInterventional Surgery listed about 600 physicians qualified to perform EVT. Taken together, the authors say interventional rads who don't have additional certification help bolster the provider pool capable of treating stroke victims. This is particularly important given an estimated 80% of patients lack direct access to an EVT center within 15 minutes of their home, especially in rural areas.

"IRs without NI fellowship training increased the number of physicians providing EVT by 21% over the number of senior members of SNIS," Martin G. Radvany, MD, with the University of Arkansas for Medical Science’s Department of Radiology, and co-authors reported.

Back in 2016, multiple societies recommended physicians complete a neurointerventional fellowship in order to perform EVT for stroke patients. The Joint Commission was set to implement the training requirement before ultimately suspending it to review possible changes.

SIR, concerned at the time the move could limit EVT for stroke, administered its survey and achieved a 17% response rate.

Radvany et al. found 85% of interventionalists providing EVT worked in Joint Commission-accredited hospitals. A majority (68%) of the 170 interventional rads performing EVT practiced in comprehensive and thrombectomy-capable stroke centers accredited by healthcare oversight group. Thirty-one percent practiced at accredited primary stroke centers and nearly 2% at non-accredited hospitals.

“The SIR survey data indicate that in the United States, IRs are providing EVT at comprehensive stroke centers where they are accountable for practices and outcomes that have led to successful accreditation,” Radvany et al. wrote, adding a recent study comparing IRs and NIs revealed no difference in procedural or clinical outcomes between the groups.

SIR is currently working with industry stakeholders and medical groups to develop stroke training courses, revise guidelines and update practice standards.

Read the entire letter to the editor in the Journal of Vascular and Interventional Radiology.

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