Who Should Treat Stroke?

David Sacks, Journal of Neurointerventional Surgery: ...There is no question that acute stroke is a major health problem, with about 800 000 strokes per year in the USA alone. Most stroke victims do not have a good recovery. US stroke healthcare costs are $41 billion a year.[1] Dollar amounts do not capture the suffering of the patient, family and friends for the death, disability and loss of independence caused by strokes. There is again no question that strokes are best prevented, but 800 000 strokes a year creates a huge need for emergency stroke treatment, including by endovascular means...

The Bottom Line is Patient Care

IA stroke therapy is highly beneficial if performed well by adequately trained physicians on appropriately selected patients. Take away any one of these three elements and benefit may become harm. Not every hospital should offer an IA stroke program. It requires tremendous resources, organization and commitment. Institutional competency is as important as physician competency. There is general (although not uniform) agreement that IA stroke is underserved within communities—24×7×365 coverage requires additional manpower. A training curriculum, combined with mastery of training and documentation of satisfactory clinical outcomes compared with national benchmarks, will confirm the skill of the endovascular stroke physician. It is time to stop looking from the perspective of an individual specialty. Vascular surgeons, cardiologists, IR, interventional neuroradiologists, interventional neurologists and neurosurgeons treat carotid disease. Endoscopy is performed by gastroenterologists, general surgeons and colorectal surgeons. Vertebral augmentation is performed by IR, interventional neuroradiologists, orthopedic surgeons, neurosurgeons and anesthesiologists. IA stroke revascularization already is, and will continue to be, performed by physicians from multiple specialties. Our commitment needs to be focused on adequate training and confirmation of good outcomes.
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