Venu Vadlamudi, MD, RPVI, FSIR


David Sacks, MD, FSIR


Martin Geza Radvany, MD, FSIR: We have two stroke pathways. The first pathway consists of transfers comprehensive stroke center (CSC) and the other focuses on patients that present directly to the hospital. Arkansas has only two CSCs, but there is a network of over 50 stroke-ready hospitals that have tele-stroke coverage, can perform a head CT and administer TPA. Patients are evaluated by the stroke neurologist using a telemedicine platform and make the decision to transfer a patient with a possible LVO. A stroke alert page goes out to the on-call stroke team to alert the team and provide an estimated ETA. This allows allocation of resources during working hours when a possible thrombectomy case is being transferred. After hours, the team is waiting at the hospital when the patient arrives. Another alert goes out when the patient arrives and the neurology residents or attending evaluate the patient. The transfers can take 2 or more hours, so repeat imaging is performed when the patients arrive. The on-call stroke interventionalist is alerted when a transfer patient arrives to be prepared to review the imaging. Approximately 50% of the interventions are from transfers. For patients who present directly


Martin Geza Radvany, MD, FSIR


to the institution, the stroke neurology team evaluates the patient and orders imaging studies. The on-call stroke interventionalist is contacted to review the imaging. If the imaging study is positive, a stroke alert is activated and the on-call team comes in.


Joseph Gemmete, MD, FSIR: We are brought into the pathway when a patient has an NIH stroke scale score greater or equal to 8, or with an LVO determined on imaging. Our hospital has a stroke response team called the Brain Injury Group that includes an ER physician, stroke neurologist, endovascular specialist and anesthesiologist on the paging alerts.


Joseph Gemmete, MD, FSIR


What does training and credentialling for stroke care look like at your institution? Are there policies for certain procedures, such as who can place an intracranial stent?


VV We follow the most recent SIR 26 IRQ | SUMMER 2021 stroke training guideline document


The on-call stroke interventionalist is contacted to review the imaging. If the imaging study is positive, a stroke alert is activated and the on-call team comes in.


for stroke credentialing and training requirements. Intracranial stenting is performed by formally trained neurointerventionalists in our system. These are quite rare cases in the acute setting but do occasionally come up.


DS Our hospital uses both IR and endovascular neurosurgeons


to provide stroke interventions. The neurosurgeons are considered qualified based on their fellowship training. The IR physicians have been performing stroke interventions for 20 years and had a training requirement of 10 cases, which would not be the training requirement today. We do not have separate privileging for intracranial stents.


MR Our institution currently has four


with radiology backgrounds. The NIR physicians perform intracranial stenting procedures.


JG At our tertiary academic hospital we require an endovascular


neurosurgery or interventional neuroradiology (INR) fellowship with CAST certification. Only endovascular neurosurgery or INR fellowship trained physicians can place intracranial stents.


There are informal pathways for IRs-in-training to pursue neuro IR, but what is your advice for established IRs who may be trying to break into stroke care?


VV For established IRs looking to get into stroke care, the key steps


are clinical evaluation and ability to co-manage these patients (depending on local neurology expertise), understanding of neuroimaging beyond the automated output from some of the commercially available software


fellowship-trained NIR attendings


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