• Cerebrovascular Disease
• Interventional Techniques & Devices

In a plenary session, Jacques Moret, MD, Beaujon University Hospital, Clichy, France, made an impassioned plea to interventional cardiologists and interventional radiologists to join neurologists in treating stroke patients. World Health Organization statistics show that in 2000, 1.1 million stroke events occurred in Europe. With a growing population aged >65, more than 1.5 million annual stroke events are expected in Europe by the year 2025 [Truelsen T et al. Eur J Neurol 2006]. Neurologists and interventional neuroradiologists are treating increasing numbers of patients with stroke for a variety of reasons, but patient care should be the most important reason. In some countries, interventional cardiologists have become more involved in stroke care.

Prof. Moret predicts that over the next few years, mechanical thrombectomy will become the preferred treatment for acute ischemic stroke. Comparing medical thrombolysis with mechanical thrombectomy is like comparing “driving a horse[-drawn] cart and piloting a space shuttle.” Treatment of stroke with chemical thrombolysis is relatively straight forward and predicated on dosing algorithms, while successful mechanical thrombectomy requires a skilled operator with technical proficiency. A busy center performs 120 to 150 thrombectomies per year and employs 3 to 4 interventionalists, meaning that each operator will perform approximately 40 procedures per year. According to Prof. Moret, skilled, safe, and upgraded procedures cannot be performed with so little practice.

In some places, the growth of mechanical thrombectomy has led to a potential shortage of interventional neuroradiologists capable of performing these procedures. Prof. Moret proposed that interventional cardiologists as well as interventional radiologists, become involved in performing mechanical thrombectomy to help fill critical voids where they exist. Interventional cardiologists and interventional radiologists are skilled at endovascular interventional procedures, whereas neurologists do not have this expertise. There is commonality among interventional cardiologists and radiologists, as both contend with many of the same situations, including medical emergencies, acute thrombosis, and management of adjunctive antithrombotic therapy. By using new technology such as computed tomography angiography to visualize the cerebral vessels, the proximal and distal vessel around the clot can be better evaluated and a stent retriever system can be delivered with optimal control of the distal end.

Selecting appropriate stroke patients for mechanical thrombectomy, as well as optimizing medical management for these patients, will continue to be the primary responsibility of neurologists. However, Prof. Moret believes that interventional cardiologists and radiologists can and should become more involved. “When mechanical thrombectomy is indicated, there is no place for doctors lacking skill,” said Prof. Moret. Interventional neuroradiologists, radiologists, and cardiologists should be involved in performing mechanical thrombectomies, with the primary goal being better patient care.

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