Experienced Cardiologists Can Also Perform Stroke Thrombectomy

Cardiologists with proficiency in cardiac interventions can competently perform stroke thrombectomy after a short period of training, according to a new study.

Researchers at University Hospital Kralovske Vinohrady (FNKV; Prague, Czech Republic) conducted a retrospective study that analyzed the learning curve effect when FNKV established a new stroke thrombectomy program in the existing cardiac catheterization lab in 2012, in close cooperation with neurologists and radiologists. The decision to perform catheter-based thrombectomy in the 333 patients was made by a neurologist, based on acute stroke clinical symptoms and CT angiographic findings. The primary endpoint was functional neurological outcome, per Modified Rankin Scale (mRS) score at three months.

The results revealed that clinical mRS outcomes did not vary significantly across years (2012 to 2019). Symptomatic intracerebral hemorrhage occurred in 19 patients (5.7%), and embolization in a new vascular territory occurred in six patients (1.8%), outcomes that are similar to those of established neuroradiology centers. In addition, the desired clinical results were achieved from the onset of the program, after the cardiologists were trained by an interventional radiologist on the thrombectomy procedure. The study was published on April 12, 2021, in JACC: Cardiovascular Interventions.

“There are not enough neuro-interventionalists in Europe. Interventional cardiologists can perform thousands of procedures every year, whereas a neuro-interventionalist will at best perform hundreds a year. It is quicker and simpler to train the cardiologist to do it,” said senior author Petr Widimsky, MD. “The cath lab is open 24/7, but if we only have one neuro-interventionalist, we cannot offer a 24/7 service for stroke thrombectomy. But if we merge with cardiology then we can.”

“Interventional cardiologists are used to performing carotid and coronary artery stenting; the thrombectomy procedure is different to coronary angioplasty, but it is not more difficult. Actually, I think coronary angioplasty can be more difficult,” concluded Dr. Widimsky. “I think interventional cardiologists can learn what they need to know in about six months. I would recommend they should watch about 50 procedures and perform at least 25 under supervision.”

“To be able to guarantee optimized stroke therapy as soon as possible, disputes over competence among the individual medical societies involved must be ended,” added Marius Hornung, MD, and Horst Sievert, MD, of CardioVascular Center Frankfurt (Germany), in an accompanying editorial. They advocate the creation of interdisciplinary teams and appropriately trained and experienced physicians, regardless of their specialties, to perform rapid acute stroke interventions and endovascular thrombectomy.

Related Links:
University Hospital Kralovske Vinohrady