Society of Neuro Vascular Interventions | | neuro interventionists, neuro surgeons, neuro radiologists, neuro physicians

Justification

Fellowship in Nurovascular Intervention

(Interventional Neurology/ Endovascular Neurosurgery)

The field of Neuro Intervention has now become established as a separate and new subspecialty in the field of minimally invasive therapy involving the central nervous system. Devices specifically approved for treatment of stroke, intracranial cerebral aneurysms, cerebral arteriovenous malformations, head, and neck tumors, and traumatic vascular lesions, have all gained FDA approval, with specific indications for therapy in the brain, head and neck, and spinal cord region. These devices include microcatheters, microguidewires, detachable coils, balloons, stents, particulate embolic materials, and other newer embolic agents.

Training programs throughout the United States, Canada, Europe, and Japan have now become established, specifically to train physicians with a background in the neurosciences, particularly in neuroradiology, neurology and vascular neurosurgery, in these newer techniques.

Stroke is one of the leading causes of mortality and morbidity. According to World Stroke Association ‘1 in 6’ people will have stroke in their lifetime. 80% of stroke is ischemic. Till recently the only approved drug for thrombolysis was rTPA. But with recent endovascular trials using stent retriever it has been established as the standard of care for Acute Ischemic Stroke with large vessel occlusion. In India there are hardly any Neuro Interventionist trained to do endovascular treatment for acute ischemic stroke. Like cardiology many neuroscientists should be properly trained to benefit patients and reduce disability and death.

Course Contents

.01 Anatomic and physiologic basic knowledge

Basic knowledge in arterial angiographic anatomy of the brain, spine, spinal cord, and head and neck

Venous angiographic anatomy of the brain, spine, spinal cord, head and neck

Collateral circulation

Dangerous anastomosis

Cerebral blood flow

Autoregulation

.02 Technical aspects of Neuro Intervention, including:

Femoral artery and arterial access and closure

Guiding Catheter/ Sheath deployement

Microcatheters and microwires

Balloons, stents, stent retrievers, embolic protection devices

Flow divertor stents

Embolic agents – coils, liquids

Basic knowledge of various types of Neuroanesthesia used for interventional procedures

Complications of procedures: prevention, recognition and management

.03 Pharmacologic agents

Contrast materials

Provocative testing

Anticoagulant, antiplatelets and GP2b3a inhibitors

Thrombolytics

Anti-vasospasm agents

.04 Tumors of the head, neck, spine, and central nervous system

.05 Revascularization for occlusive vascular diseases

Arteriopathies

Atherosclerotic lesions

Techniques of revascularization: balloon angioplasty, thrombolytics, and stenting (includes extra and intra cranial carotids and vertebral and their branches)

.07 Coagulation cascade

.06Brain and spinal cord arteriovenous malformation, arteriovenous fistulas of the brain, spine, spinal cord, and head and neck vascular malformations; ischemic stroke; and cerebral aneurysms

Classification

Clinical presentation

Natural history

Epidemiologic data

Hemodynamic basis

Indications for treatment

Contraindications for treatment

Therapeutic techniques: exposure, participation and supervised hands-on training in performance of diagnostic and therapeautic interventional procedures

Combined therapies

.08Embolization for epistaxis or other causes of haemorrhagee

.09IPSS

.10Balloon test occlusions

.11Radiation protection and side effects

.12Major trials and Imaging.

.13Clinical assessment including various scales like NIHSS, mRS etc.

ELIGIBILITY CRITERIA & OTHER INFO

DM/DNB Neurology, DM Neuroradiology, MCh/DNB Neurosurgery.

Duration of course:

2 years.

Breakup of training period:

3 months: Neurovascular anatomy and pathophysiology, Reporting, Neuropharmacology, Pre-op and post-op care.

9 months: Diagnostic cerebral and spinal angiograms

1 year:

Therapeutic Neuro Interventional procedures.

There will be rotation of 2 to 4 weeks in another training centre during this period.

Eligibility Criteria:

Centre Eligibility Criteria:

The centre should have full time Neurologist, Neurosurgeon and Neuro Interventionist. It should have dedicated Neuro-ICU, CT, MRI, and Cath lab facility.

Fellow ratio:

Faculty to Fellow ratio:

One full time faculty for a fellow.

Publications:

PUBLICATIONS AND PRESENTATIONS:

The fellow should complete at least 2 publications in 2 years in an indexed journal (original article, case series, case report) and should attend 1 national conference per year.

Training

MINIMUM TRAINING REQUIREMENTS:

The fellow will get to do at least 125 angiograms and 30 intervention cases (assisted or supervised) in his training period of 2 years. Simulator training for skill development will be arranged at least once per year.

EVALUATION:

Logbook should be maintained of all the procedures and seminars.

Exit exam will be conducted at the end of 2 years (both theory and viva) with one internal examiner (the programme director) and one external examiner. .

SNVI certified

CERTIFICATION:

The fellow will be awarded a SNVI certified ‘Fellowship in Neurovascular Intervention’ after he completes all the training requirements and passes the exit exam. The certificate will be signed by the respective Programme director and President of SNVI.