programs, and, of course, technical performance of thrombectomy including carotid stenting and recognition/ management of complications. Stroke is truly a very complex disease state and LVO thrombectomy needs to be performed by physicians fluent and comfortable in all the different aspects of stroke care. And paramount to all this is a robust quality assurance and improvement program.


DS An IR looking to provide stroke care needs to understand that


the intracranial circulation is not simply another vascular bed. The end organ and physiology and the blood vessels are unique. Certainly, wire and catheter skills are complementary, but not identical.


MR As with other procedures, an IR looking to provide stroke care


needs to become educated about stroke so that they can speak the same language as other specialists involved in the care of this patient population. The catheter skills needed for stroke intervention can be learned, ideally from someone who is experienced in endovascular treatment of patients with ischemic stroke.


JG You’ll need to get proper training and mentorship with someone


in INR, in addition to attending stroke conferences and INR meetings while and reading about the subject. Make sure you have experience performing cerebral angiography with good microcatheter skills.


What do you think is the next challenge for IR stroke care?


VV I think the next challenge is really the next opportunity for IRs in


stroke care—establishing formal training pathways into neurointerventional radiology from IR. Though there will be a lag period in this evolutionary step, it will be an important one to allow IRs to continue their involvement in stroke care in the future.


interesting challenge. The adoption of online learning and webinars has made education more accessible, and electronic communication may also allow case observation and even remote proctoring. However, novel means of training will need to maintain favorable outcomes. Otherwise, local availability of stroke interventions will be inferior to transport to a centralized facility, despite the time cost.


DS The future of training is an MR I agree. The imaging and clinical evaluation can be learned via


a course, but the hands-on training and proctoring remain a challenge. Simulators and remote proctoring may be able help alleviate some of this challenge, but at this time, performing procedures under the guidance of an experienced operator remains essential for those starting out.


JG I feel our next challenge is for IRs to be recognized as players in the


stroke field. This will only be possible by showing outcomes similar or better than those of the other specialties performing these procedures.


SIR stroke standards


SIR’s Guidelines and Statements has published multiple standards on stroke care, such as:


• Position statements • Research reporting standards • Training and credentialling • Quality improvement


• Collaboration and endorsements


These statements cover everything from training for endovascular stroke to standards for carotid stenting, stroke prevention and cervicocerebral angiography.


View the stroke standards on bit.ly/stroke-guidelines, jvir.org/ content/reporting or download the new SIR Guidelines app from the Apple app store at bit.ly/SIR-guidelines.


The SIR Guidelines app is free to use and allows health care workers to quickly access evidence-based recommendations in an easy-to- use, point-of-care format that simplifies clinical decision-making.


The initial release includes an interactive periprocedural recommendation calculator that generates scenario-specific anticoagulation and antibiotic recommendations based on the SIR consensus guidelines. Users can input medications and patient factors to generate recommendations tailored for the patient’s and procedural bleeding risk.


The app will be continually updated to include new Clinical Practice Guidelines and tools to assist in clinical decision-making.


sirweb.org/irq | 27


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