Feature


The state of neurointerventional care


Stroke panel By Martin Geza Radvany, MD, FSIR, and Venu Vadlamudi, MD, RPVI, FSIR


D Education update: Accessible stroke education


The transition to virtual meetings in the COVID-19 era affected planned in-person stroke education activities such the SIR Stroke Course at the Annual Scientific Meeting and the second iteration of the SIR Stroke Imaging Boot Camp. The Interventional Neuroradiology Service Line and the Stroke Advisory Group, with strong support from SIR leadership, have been able to make the transition and continue to provide stroke education to SIR members.


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With the closing of the ACR Learning Center last fall, the SIR Stroke Imaging Boot Camp needed to be restructured into an online-only activity. To this end, the SIR Stroke Series was developed as a four-module webinar mini course covering topics ranging from the diagnostic workup of acute stroke, advanced stroke imaging and AI, COVID-19 and stroke, and optimization of case selection. IR stroke experts were joined by other neurovascular experts including Ashutosh Jadhav, MD, PhD, of Barrow Neurological Institute; Waleed Brijinkji, MD, of the Mayo Clinic; and Lori Jordan MD, PhD, with Vanderbilt University Medical Center.


The series culminated in the inaugural SIR Stroke Case Conference in which faculty present challenging cases followed by a panel discussion. With the success of the inaugural case conference, a quarterly SIR Stroke Case Conference was launched to provide a forum in which IR attendings and trainees have the opportunity to present challenging stroke interventions and discuss the cases with a panel of experienced stroke specialists.


Planning is currently underway for another fall SIR Stroke Series which will include a variety of lecture webinars. This will again be a virtual meeting in which we plan to leverage the virtual meeting platform to invite presenters who might not otherwise be able to participate in an in-person format.


With the resumption of “in-person” meetings on the horizon, we hope to expand the educational offerings to include hands-on device and simulator training and we look forward to seeing everyone in person next spring at the SIR Annual Scientific Meeting and SIR Stroke Course.


uring the June Stroke Case Conference, Venu Vadlamudi, MD, RPVI, FSIR, Martin Geza Radvany, MD, FSIR, Joseph


Gemmete, MD, FSIR, David Sacks, MD, FSIR, and Paul S. Brady, MD, served on the panel, both presenting cases and asking questions of the other presenters. While the SIR Stroke Case Conference fosters discussion on topics such as the critical role of timing in stroke care or difficult technical scenarios, the series also highlights the differences between institutions and the challenges facing IRs involved in stroke care.


IRQ spoke with Drs. Vadlamudi, Radvany, Gemmete and Sacks on the structure of their response teams, the challenges of the specialty and the need for training pathways.


Does your institution have a stroke response team? At what point are you brought into the pathway for treating a stroke patient? Venu Vadlamudi, MD, RPVI, FSIR: Our institution does have a stroke response team, comprised of the stroke response nurse, neurologist and IR. The IR is brought into the case when either the neurologist has a high pre- test suspicion of large vessel occlusion (LVO) stroke or following advanced imaging for LVO evaluation.


David Sacks, MD, FSIR: The interventional physician is contacted when the stroke neurologist is evaluating a patient with clinical findings suspicious for an LVO. Since it can take time to set up the room, or have the interventional team arrive from home for an after-hours case, we want to be called based on clinical suspicion rather than waiting for positive imaging. If imaging is negative, the team goes home. My estimate is that we cancel no more than 10–20% of call-ins. This approach also works well for cases being transferred from satellite hospitals. If imaging at the satellite hospital is sufficient and the transfer time is short, the patient can go directly from the helipad to the IR suite.


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