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Who Should Be Treating Your Stroke? Columbia Physicians Work to Develop Training Guidelines for Physicians Performing Mechanical Thrombectomy

Silhouette of a hand holding a head with the brain highlighted.It may start as numbness on one side of the face. In some cases, one side of the body may suddenly be weak and unable to move well.

In others, there’s sudden confusion, vision changes or loss of coordination causing inability to walk.

Whatever the symptoms, a stroke is a medical emergency needing immediate attention. At the same time, watching a loved one experience the signs of a stroke can be a frightening experience.

What will happen? Where to go for help?

The answer is a little easier in New York City, where there are dedicated facilities and medical specialists such as those at Columbia University Medical Center/NewYork-Presbyterian Hospital. In fact, researchers have found that stroke patients have a lower death rate at New York City hospitals.

The choices may be less clear in another state or country. How can patients be certain they’re getting the best stroke treatment?

Dr. Sean Lavine and Dr. Philip Meyers from Columbia’s Department of Neurosurgery are working hard to address this question. They recently lent their expertise to the cause by joining an international group of renowned physicians to author an article, “Training Guidelines for Endovascular Ischemic Stroke Intervention: An International Multi-Society Consensus Document.

A stroke occurs when blood can’t properly get to the brain. There are two major types of stroke: A hemorrhagic stroke happens when bleeding occurs after a blood vessel ruptures. In an ischemic stroke, there is a blood clot that blocks the flow of blood to the brain.

In both cases, since the brain cells can’t get oxygen and nutrients from the blood, the cells begin to die. The victim then loses the ability to do certain things controlled by those brain cells. For example, there may be a loss of speech or decreased ability to use certain muscles.

The article by Drs. Lavine and Meyers and their colleagues focuses on a newer treatment for ischemic stroke called mechanical thrombectomy. In this procedure, the doctor inserts a small catheter into an artery that can be easily reached, such as one in the groin. He can then thread the tip of the catheter to the artery in the brain that contains the clot and mechanically remove it.

It’s great news that patients who undergo this procedure have improved outcomes when certain large vessels in the brain are involved. But it’s a sophisticated procedure, and time is of the essence in all stroke treatment. Who should be performing it? Drs. Lavine and Meyers, along with their international colleagues, address this question in the article.

First, the doctors should complete residency training (training after medical school) in radiology, neurology or neurosurgery accredited by the Accreditation Council for Graduate Medical Education (ACGME). During this time, they work to become experts in diagnosing and treating stroke. Training in reading common tests such as CT, MRI and angiography must be featured.

The authors then recommend that these specialists spend at least another year learning the complex and delicate task of treating stroke directly, working within the arteries of the brain. This involves both cognitive and technical expertise: They have to know the different types of equipment and how to use them.

Just as no two people look alike, not everyone’s arteries are the same, and doctors have to know how to deal with variations in anatomy and best methods to treat the many manifestations of acute stroke.

Finally, the training doctors need to know how to care for patients when the procedure is finished. They should have the benefit of working in a facility with a Neurological Intensive Care Unit, a specialty ICU dedicated to stroke patients, with the most modern equipment and specialty personnel, like the one here at Columbia. And they should see and treat a lot of stroke cases!

If you have a loved one who may be experiencing a stroke, it’s reassuring to know that Columbia Neurosurgery physicians and their colleagues are working to define the best training for doctors worldwide who perform endovascular thrombectomy for stroke.

Learn more about Dr. Lavine on his bio page here.
Learn more about Dr. Meyers on his bio page here.

Read the article excerpt here.

Learn more about Columbia Neurosurgeons and the Department of Neurosurgery at Columbia here.

Image credit: © [geralt]/pixabay

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