乌鸦传媒

LOS ANGELES -- As clinical trial evidence turned the corner for mechanical thrombectomy in 2015, what few procedures were done remained solidly the province of radiologists, a study of Medicare data showed.

Looking at a nationally representative 5% sample of Medicare beneficiaries between January 1, 2009, and September 30, 2015, only 555 thrombectomy procedures for acute ischemic stroke were done among nearly 78,000 stroke hospitalizations.

While 61.4% of them were done by radiologists, an equally high proportion of operators had dedicated neurointerventional fellowship training (66.1%), albeit of unknown type or quality, Hooman Kamel, MD, Weill Cornell Medical College in New York City, and colleagues reported here at the and online in

Neurologists and neurosurgeons roughly split the rest not done by radiologists -- 19.8% and 16.4%, respectively -- along with a sliver (2.4%) done by an assortment of other physicians.

"Clinician characteristics did not change significantly after December 17, 2014, when the first trial to show a clinical benefit for thrombectomy was published," the researchers noted in the paper.

Early in 2015, a subsequent series of trials confirmed that, with advanced imaging-selection of patients, mechanical thrombectomy held a significant outcome benefit for large vessel strokes, kicking off a rapid uptake in the procedure.

How the workforce doing these procedures might have changed since the end of the study period isn't clear.

Kamel's group pointed to arguments "that a workforce shortage exists that could be filled by non-neuroscience clinicians with expertise in catheter-based procedures. Neurointerventionalists have countered that they are available to most U.S. patients, but vascular neurologists have nevertheless raised concerns about a shortage."

"I know in my own institution right now, radiologists aren't doing the procedures," commented Ralph Sacco, MD, of the University of Miami, and president of the American Academy of Neurology.

"Radiologists are phenomenally good at working with catheters and often they are part of a team," he told 乌鸦传媒, "but it's hard to say, and I've never seen differential data regarding outcomes by radiologists, a neurologist, or even interventional neurosurgeon."

A lot of the future landscape may be up to trainees, Sacco noted. "It's hard to say what the landscape will look like in the future. But our belief is that more neurologists will become interventional neurologists ... Obviously, the demand for more people to do interventional procedures is rapidly rising."

The researchers suggested that their study may help "inform plans for optimizing systems of acute stroke care across the United States."

Comment