SIR Publishes Training Guidelines for Stroke Treatment

December 1, 2009—In the Journal of Vascular and Interventional Radiology (JVIR), the Society of Interventional Radiology has published training guidelines for intra-arterial, catheter-directed treatment of acute ischemic stroke (2009;20:1507-1522). A special writing group for the society composed of J.J. Connors, MD, et al developed and authored the guidelines. A commentary on the guidelines by writing group members David Sacks, MD, and Dr. Connors was also published in JVIR (2009;20:1523-1526). The author advised that these guidelines are supported by peer-reviewed published standards and should be mandated for emergency endovascular stroke therapy, analogous to vascular interventions for acute myocardial infarction or other highly morbid conditions.

A summary of the physician training requirements is outlined in Table 1 of the document. Specifically, the guidelines state that sufficient training to meet the basic qualifications should be provided in a neurointerventional fellowship and should include documented experience treating acute ischemic strokes as primary operator, either within an accredited endovascular surgical neuroradiology program or an equivalent nonaccredited program. Such training should include attestation by the fellowship director that the fellow has achieved adequate experience and is competent to independently treat strokes.

For those lacking formal neurointerventional fellowship training, specific training is necessary to perform catheter-directed stroke therapy. Technical ability is demonstrated with superselective microcatheter experience in other vascular beds and with training in neurointerventional-specific technical skills as described in the guidelines. The specific content of testing for cognitive requirements is provided in the appendix to the guidelines.

Table 2 of the guidelines provides a thorough description of physician and facility requirements for intra-arterial, catheter-directed treatment of acute ischemic stroke. Among these are that the facility at which these procedures are performed must have stroke treatment processes of care and quality assessment programs that optimize stroke outcomes, physicians capable of managing pre- and postprocedural neurocritical care of endovascularly treated stroke patients, and daily around-the-clock availability of neurosurgical care to treat possible complications of stroke therapy. The guidelines are available to subscribers online and in the December print issue of JVIR.