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interventional after neurology

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Guest extrachromasome

Is it possible to be trained in interventional neurovascular techniques (stroke treatment) as part of a stroke fellowship? Or is this exclusively for radiologists.

 

Thanks

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Guest Kirsteen

Hi there,

 

I was having a look at this a little while ago and it seemed that one popular sequence of Interventional Neuroradiology training was: 1) completion of a Radiology residency; 2) completion of a Neuroradiology fellowship (often 2 years); 3) completion of an Interventional Neurorads fellowship (1 year).

 

Given the blurred boundaries between certain surgical and radiological realms, it seems plausible that traditional radiological interventional training could be offered within surgical programs (for example, UofT has a program in Image-Guided Surgery that is in its inaugural year this year). However, I'm not sure about the jump between Neurology and Interventional Neuroradiology.

 

Cheers,

Kirsteen

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Guest satsumargirl

Hey,

 

I had started looking into this a little while ago...but forgot about it, so thanks for reminding me!

 

Anyway, it seems you can do interventional neurology in the US. Here is a link to one place in Florida. But there were others I found as well (John Hopkins I think and others I don`t really know about since I am not American)

 

www.clevelandclinic.org/florida/research/residency/vascularNeurology.htm

 

But I do not know of any programs in Canada. Doesn`t mean it doesn't exists. Just haven`t thoroughly researched it.

 

If you find anything, keep us posted!

 

Sats

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Thought I would post on update to this question.

I recently organised a neurology career night and asked about interventional "neurology".

 

The response was not terribly encouraging. Apparently, this year, Canada will graduate its first "interventional neurologist". It apparently took some convincing for the program to train this neurologist and nobody was sure where this person would work once done. Reason being, it is radiology that pays for and runs to interventional "suites". So if an interventional radiologist is doing the procedure, they have it set up so that that radiologist reads films while the pt is getting preped (anaesthesia etc...). So that way the radiologist is actually generating income. If they had an interventional neurologist, the department would lose money since the neurologist cannot read films while waiting and cannot generate income.

 

So that seems to be the current state of things.

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Hi,

 

There are a number of such turf wars occurring between the Interventional Rads folks and practitioners in other domains. I know of one Canadian Interventional group who resolved the situation by coming to an agreement with a set of internists who wished to perform interventional procedures on their organ of specialty. The agreement consisted of a randomized controlled trial where patients were randomized to have the procedure performed either by an Interventional Radiologists or an Internist. The results clearly demonstrated that less morbidity and mortality was incurred by the patients who underwent the procedures at the hands of the Interventional Radiologists, and as such, at that centre, the interventional suite privileges for the internists have been revoked and those procedures are now performed exclusively by the Interventional Rads guys.

 

Cheers,

Kirsteen

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Hi,

 

There are a number of such turf wars occurring between the Interventional Rads folks and practitioners in other domains. I know of one Canadian Interventional group who resolved the situation by coming to an agreement with a set of internists who wished to perform interventional procedures on their organ of specialty. The agreement consisted of a randomized controlled trial where patients were randomized to have the procedure performed either by an Interventional Radiologists or an Internist. The results clearly demonstrated that less morbidity and mortality was incurred by the patients who underwent the procedures at the hands of the Interventional Radiologists, and as such, at that centre, the interventional suite privileges for the internists have been revoked and those procedures are now performed exclusively by the Interventional Rads guys.

 

Cheers,

Kirsteen

 

Hey Kirsteen,

 

Do you have a reference for this RCT? It sounds like an interesting read.

 

G

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Here is a similar kind of article re: urology vs radiology from the University of Ottawa.

 

Access Related Complications During Percutaneous Nephrolithotomy: Urology Versus Radiology at a Single Academic Institution.

 

The Journal of Urology, Volume 176, Issue 1, Pages 142-145

 

J. Watterson, S. Soon, K. Jana

 

Division of Urology, University of Ottawa General Campus, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, Canada. jwatterson@ottawahospital.on.ca

 

PURPOSE: A recent survey revealed that only 11% of urologists performing percutaneous nephrolithotomy routinely obtained percutaneous access themselves. Reasons for this trend may include lack of training, comfort level and perceived need for radiological involvement. In this study we evaluated percutaneous access for percutaneous nephrolithotomy obtained by interventional radiologists or a urologist at a single academic institution, and compared access trends and complications. MATERIALS AND METHODS: Two cohorts of patients who had undergone percutaneous nephrolithotomy between 1999 and 2003 were reviewed. Percutaneous access was performed by a group of interventional radiologists (group 1) or a urologist (group 2). An access difficulty score was calculated using patient, stone and procedural variables. Primary outcome measures of percutaneous access complications such as bleeding, failure of access, pneumothorax or other organ injury were compared between groups. Secondary outcome measures of stone-free rates were also compared. RESULTS: In groups 1 and 2, 54 and 49 patients were identified with a total number of tracts of 54 and 60, respectively. Both groups had similar rates of supracostal access. Mean access difficulty scores were similar between groups. Access related complications were significantly higher in the radiology access group (15 vs 5). Stone-free rates were significantly better in the urology access group (86% vs 61%). CONCLUSIONS: Despite similar access difficulty between groups, access related complications were less and stone-free rates were improved during urologist acquired percutaneous access. Urologists instructed in percutaneous access may be able to provide improved stone-free rates during percutaneous nephrolithotomy while minimizing access related complications.

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Hey Kirsteen,

 

Do you have a reference for this RCT? It sounds like an interesting read.

 

G

Hi there,

 

It was a Radiology Program Director who mentioned the trial to me (which had occurred at his university), but I don't believe that the results were ever published. From what I understand, it was run simply to sort out this one turf war.

 

Cheers,

Kirsteen

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Here is a similar kind of article re: urology vs radiology from the University of Ottawa.

Hi there,

 

Thanks for adding the reference to this study. I just had a wee look on Pubmed and it was published in July 2006. I'm sure we'll be seeing similar such studies in the near future given the various situations where clinical equipoise, and related turf wars, are present.

 

Cheers,

Kirsteen

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On 1/10/2017 at 10:04 PM, Let'sGo1990 said:

Any update on this? I hear that an interventional neurologist finished training in Toronto recently and is now practising in the Hamilton area.

I know this is late but I can tell you that the Interventional neurologist in Hamilton are valued and very well-regarded here.

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On 12/9/2006 at 11:06 AM, Satsuma said:

Thought I would post on update to this question.

I recently organised a neurology career night and asked about interventional "neurology".

 

The response was not terribly encouraging. Apparently, this year, Canada will graduate its first "interventional neurologist". It apparently took some convincing for the program to train this neurologist and nobody was sure where this person would work once done. Reason being, it is radiology that pays for and runs to interventional "suites". So if an interventional radiologist is doing the procedure, they have it set up so that that radiologist reads films while the pt is getting preped (anaesthesia etc...). So that way the radiologist is actually generating income. If they had an interventional neurologist, the department would lose money since the neurologist cannot read films while waiting and cannot generate income.

 

So that seems to be the current state of things.

Yeah that is common - although I will mention that also neurosurgery can be trained to do this as well, and they cannot do imaging studies between cases either. There are two of those for instance at Ottawa. 

There are always things to do but I think the bigger point is just the organization of things. If you do IR neuro then it is tricky doing it between two groups no matter who they are. 

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I would definitely not go into neuro if this is your intent.  I finished a year ago, and while on stroke call we would come and essentially watch (sometimes help if there was not many interventional learners) the mechanical thrombectomy (clot removal) post stroke.  For one, this is only available in major centers, so its not like you can just open up your own clinic and do this...you need the hospital set up.  You would get A LOT of resistance from IR if you tried to seriously do this as part of your practice.  I am thinking they would defend that turf HARD.  Getting accepted into interventional fellowships would likely be met with much much resistance.  Clearly it happened as the poster above described, but I just want to emphasize how rare that is (I have never seen or heard of it).

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