FAIRFAX, Va., Nov. 18 /PRNewswire-FirstCall/ -- A multisociety consensus document entitled “Training, Competency, and Credentialing Standards for Diagnostic Cervicocerebral Angiography, Carotid Stenting, and Cerebrovascular Intervention,” is now on-line in “Radiology,” the official journal of the Radiological Society of North America, the first of several medical journals that will concurrently publish this joint statement. The landmark document defines minimum standards for the training, knowledge, and experience necessary to perform carotid stenting and other diagnostic and therapeutic cerebrovascular procedures, all of which include stroke, one of the most disabling, costly and feared of all medical conditions, as a specified risk.
Written by a multidisciplinary group led by John J. Connors, III, M.D., immediate past president of the American Society of Interventional and Therapeutic Neuroradiology (ASITN), the document represents the first project undertaken by the newly formed NeuroVascular Coalition, a group comprised of medical societies with shared interests in stroke reduction, acute stroke treatment, and cerebrovascular interventions. The NeuroVascular Coalition represents all medical specialties with formal ACGME-approved training in the cervicocerebral vasculature and associated neurological conditions. In addition to ASITN, the other collaborating medical societies include the American Academy of Neurology, the American Association of Neurological Surgeons, the American Society of Neuroradiology, the Congress of Neurological Surgeons, the Cerebrovascular Section of the American Association of Neurological Surgeons/Congress of Neurological Surgeons, and the Society of Interventional Radiology.
According to Gary Duckwiler, M.D., Professor and Fellowship Director of Interventional Neuroradiology at the University of California, Los Angeles and President of the ASITN, the document symbolizes a united effort on the part of multiple practitioners including neurointerventionists, neuroradiologists, interventional radiologists, neurologists and neurosurgeons to specify minimum standards in order to ensure that the benefits of carotid stenting and other neuroendovascular interventions outweigh the risks, namely stroke. “With the input of so many specialties, each with their own knowledge base and treatment perspective regarding cerebrovascular disease, this document represents collaboration at its best and more importantly, identifies the basic skills and knowledge necessary to perform these procedures safely,” said Duckwiler.
With the potential for hundreds of thousands of carotid stenting procedures to be performed yearly in the United States by physicians including neurointerventionists, peripheral interventionists, vascular surgeons, neurosurgeons, neurologists, and cardiologists, all with different experience and skill levels, David Sacks, M.D., Standards Division Councilor for the Society for Interventional Radiology (SIR) and a contributing author to the document, says that a competency statement is a significant effort in achieving uniformity. Whereas one physician may have vast experience in the utilization of catheters but not a strong cognitive understanding of the brain and its associated pathophysiology, Sacks says, another may demonstrate solid cognitive skills but lack the technical skills necessary for endovascular treatment of cerebrovascular disease. “As adequate cognitive and technical training in both diagnostic and interventional procedures will optimize outcomes and prioritize patient safety, the representatives of the NeuroVascular Coalition have joined together to establish concrete requirements which reflect an appropriate and sufficient minimum level of experience and skill in all areas concerned.” says Sacks.
Specifically, those requirements, as outlined in the document, mandate a minimum of six months of formal neuroscience training including neuroradiology, neurosurgery, neurology, and vascular neurology in ACGME- approved programs for any practitioner performing cervicocerebral interventional procedures, including carotid stenting. Also, a total of 100 appropriately supervised diagnostic cervicocerebral angiograms should be completed before post-graduate training in cervicocerebral, interventional procedures, including carotid stenting. Thirdly, the NeuroVascular Coalition recommends a defined training pathway for carotid stenting for any qualified practitioner.
According to Anthony Furlan, M.D., who contributed to the document on behalf of the American Academy of Neurology, such standards are commensurate with the risks associated with carotid stenting. As detailed in the document, randomized controlled trial data indicate stroke and death rates for carotid stenting ranging from 4.4% to over 12% at 30 days, with a one-year stroke and death rate of up to 12%. “These numbers alone reinforce the need for standards in experience and skill level,” Furlan said. “The consequences of operator inexperience and lack of knowledge of the brain circulation can be devastating for the patient. The purpose of these standards is not to exclude specialties from performing procedures but to improve the quality of patient care by establishing minimal training and credentialing criteria.”
Sub-optimal outcomes are often not only harmful for patients, but also for hospitals and the overall efforts to lower the risk of stroke, added Connors. “Hospital credentialing committees are expected to guarantee that individual physicians diagnosing and treating cerebrovascular disease with endovascular procedures have sufficient formal training, knowledge, and experience to not only select suitable patients for appropriate therapies, but also perform procedures with the best possible outcomes.”
NeuroVascular Coalition
CONTACT: Rebecca Hall, Public Relations Specialist, +1-305-519-2094, forthe NeuroVascular Coalition
Web site: http://www.asitn.org/