Most Stroke Thrombectomies Performed by Dedicated Neurointerventionalists

LOS ANGELES, CA—The majority of operators performing mechanical thrombectomy for acute ischemic stroke appear to have undergone appropriate training, according to a new analysis reported here at the International Stroke Conference shows.

Since the emergence of mechanical thrombectomy as an effective treatment for strokes caused by large-vessel occlusions, questions have been raised about whether there are enough neurointerventionalists to meet demand for the procedure. That, in turn, has highlighted the possibility of other types of physicians—like interventional cardiologists—filling any gaps.

To get an idea of which types of physicians are actually performing mechanical thrombectomy in the United States, researchers led by Hooman Kamel, MD (Weill Cornell Medicine, New York, NY), examined claims data spanning the years of 2009 to 2015 from a 5% nationally representative sample of Medicare beneficiaries.

They identified 555 thrombectomy procedures out of 77,774 stroke hospitalizations. The cases were most frequently performed by radiologists (61.4%), followed by neurologists (19.8%), neurosurgeons (16.4%), and other physicians (2.3%), a group that included cardiologists and vascular surgeons. About two-thirds of operators had completed a dedicated neurointerventional fellowship.

“It has been argued that a workforce shortage exists that could be filled by non-neuroscience clinicians with expertise in catheter-based procedures,” Kamel et al write in a simultaneously published research letter in JAMA Neurology. “Neurointerventionalists have countered that they are available to most US patients, but vascular neurologists have nevertheless raised concerns about a shortage.”

This study, the investigators say, “may help shed light on the current standard of care for mechanical thrombectomy and inform plans for optimizing systems of acute stroke care across the United States.”