Modern Training and Credentialing in Neuroendovascular Acute Ischemic Stroke Therapy

Background: Acute ischemic stroke (AIS) remains a significant source of morbidity and mortality worldwide. Multiple recent randomized clinical trials for AIS patients presenting with large vessel occlusion have demonstrated radical improvement in outcomes with mechanical thrombectomy (MT), which is now recognized as the new standard of care for patients presenting up to 24 hr.

Objective: To provide a perspective on training and credentialing requirements for practitioners in this field.

Methods: Relevant articles were systematically searched and analyzed. Standards for Reporting Qualitative Research guidelines were utilized.

Results: : The Committee for Advanced Subspecialty Training (CAST) brings together the principal specialties of Radiology, Neurology, and Neurosurgery. Their training standards document the most recent consensus on training for neuroendovascular surgery (NES) and include the endovascular treatment of AIS as a part of the field of NES. This unified consensus represents a significant landmark in the evolution of stroke therapy. Presently, training at most centers follows an apprenticeship type model. Simulation methods and objective performance metrics have not been widely incorporated. Maintenance of proficiency has not been conclusively addressed reflecting the overall developing nature of the field.

Conclusion: The evolution of the standard of care interventional therapy for large vessel AIS utilizing MT raises concerns regarding work force needs, training standards, competency, and credentialing requirements for practitioners. The CAST framework represents the most modern and flexible approach for both individuals and training programs. Methods based on objective performance metrics utilizing simulation as primary vehicle may be the logical next steps in the evolution of NES.