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September 4, 2019

SIR Issues Updated Training Guidelines for Endovascular Stroke Treatment

September 4, 2019—The Society of Interventional Radiology (SIR) announced the publication of updated training guidelines for interventional radiologists (IRs) performing endovascular thrombectomy to treat acute ischemic stroke. The training guidelines by David Sacks, MD, et al are currently available online in Journal of Vascular and Interventional Radiology (JVIR).

Dr. Sacks commented in the SIR announcement, “Since SIR’s first training guidelines on this topic were published in 2009, multiple randomized trials and meta-analyses have confirmed the safety and efficacy of this treatment, making it the standard of care for acute ischemic stroke. The revised training guidelines will ensure interventional radiologists are well trained to meet the critical care needs of patients and hospitals.” Dr. Sacks is an IR at Reading Hospital—Tower Health Medical Group in West Reading, Pennsylvania.

The new guidelines detail the cognitive and procedural skills that IRs must obtain and maintain to safely and effectively perform endovascular thrombectomies (EVTs)—including patient diagnosis and selection; brain imaging competencies; clinical patient care before, during, and after the procedure; and the ability to identify and manage complications.

SIR President Laura Findeiss, MD, added, “Since the inception of this treatment, IRs have worked alongside and in partnership with neurointerventional radiologists, endovascular neurosurgeons, and now interventional neurologists in providing this critical procedure for acute ischemic stroke with positive outcomes for patients.” Dr. Findeiss is an IR and Professor and Chief of Service for the Department of Radiology at Grady Memorial Hospital, Emory University School of Medicine in Atlanta, Georgia.

According to SIR, a recent Joint Commission survey found that 41% of the responding primary stroke centers that performed EVT relied on IRs to deliver this care.

Dr. Findeiss stated, “Given IR’s role in performing this procedure, and the validation of EVT’s vital role in preventing long-term disability, it is critical that we ensure that patients in communities across the country have access to well-trained IRs, among other specialists, to provide the most appropriate treatment for their condition. SIR’s revised training guidelines set standards that continue to ensure that IRs are prepared to provide high-quality care to stroke patients with large vessel occlusion.”

As noted in the document, the present guidelines focus on acquisition of knowledge with subsequent mastery validated by review from a competent and experienced trainer or proctor. Because the effectiveness of these training guidelines is to be assessed by outcomes measurement, it is required that outcomes be tracked for the purposes of documenting acceptable performance relative to previously published trials and national benchmarks. The guideline authors strongly suggest participation in a national registry to allow outcomes to be benchmarked against other participating facilities.

The guidelines recognize that there are at least three components of adequate training for competency to perform endovascular interventional procedures for acute ischemic stroke:

  • Formal training that imparts the required depth of cognitive knowledge of the brain and its associated pathophysiologic vascular processes, clinical syndromes, the full array of ischemic stroke presentations, and pre-, peri-, and postprocedural care.
  • Procedural skill, including management of complications secondary to endovascular procedures, achieved by supervised training from a qualified instructor.
  • Diagnostic and therapeutic acumen, including the ability to recognize procedural/angiographic complications. This is achieved by studying, performing, and correctly assessing an adequate number of diagnostic and interventional/endovascular procedures with proper tutelage.

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