As president of the Society of NeuroInterventional Surgery (SNIS), endovascular neurosurgeon J Mocco (Icahn School of Medicine at Mount Sinai, New York, USA) has aspired to take the baton from his predecessors and carry forward their work in improving access to adequate treatments for stroke patients. Here, he discusses the numerous efforts he and his colleagues have undertaken over the past year on this front; his views on the past, present and future of neurointerventional care; a clinical case that he still draws edification from to this day; and much more.
What initially attracted you to medicine, and neurointerventional surgery specifically?
I did not have any doctors in my family growing up, so I really did not understand what it meant to be a doctor in any specific way. The one thing I did know is that I wanted to practise a version of medicine where time was of the essence, and whether I was skilled at my job, made a real and urgent difference. I wanted to be a kind of doctor who pushed themselves to be excellent, and who saw my commitment to my craft as making a tremendous difference for patients. It turns out that those are exactly the qualities required of a neurointerventionist.
Who have your mentors been and how have they impacted your career?
I have been so incredibly fortunate to have many impactful mentors over the course of my life. However, two stand out as particularly impactful: Sander Connolly and Nick Hopkins. Both were individuals who taught me to look at the field with fresh eyes every day, to not be rooted in the dogma of the past, but instead to wonder, “how can this be done better?” Their guidance and inspiration have shaped me more than anyone, outside my family.
What were your goals when you were elected SNIS president—and would you say you have achieved said goals?
I had several goals when I became SNIS president. These included increasing the strength of our relationships with the international community; creating a more data-centric SNIS; solidifying the Neurovascular Quality Initiative (NVQI) registry; initiating new projects to inspire diversity, equity and inclusion in neurointervention; rolling out a neurointerventional match to create a fair playing field for access to quality training; and deepening our relationships with several related societies.
When I began my career, many of our constituent physicians were siloed according to their background specialty, and our respective societies were often at odds.
I believe we have been very successful in these endeavours. I want to emphasise that the operative word in that sentence is “we”. The strength of the SNIS is its board of directors and various committees, both of which are made up by amazing individuals, from diverse training backgrounds, who give their time and energy to advancing the society’s goals. Because of these wonderful people, we have created new partnerships with numerous international societies—including shared programming at our respective meetings, new societies choosing the Journal of NeuroInterventional Surgery (JNIS) as their journal, a new guidance document from the World Federation of Interventional and Therapeutic Neuroradiology (WFITN), and other exciting initiatives. On the domestic front, we are working with partner societies to establish the neurointerventional match and to inform the community of the new IR residency pathway to CAST fellowship eligibility.
We also revamped our annual Corporate Advisory Council, our annual meeting, and our webinars to all be more data-centric; we have committed to funding the roll out of NVQI to all National Institutes of Health (NIH) StrokeNet STEP centres, which will greatly enhance the rigor and volume of data collection; and we initiated a programme to bring neurointerventional doctors and engineers into childrens’ classrooms, to help children realise that doctors/scientists/ engineers are often women or come from traditionally underrepresented minority groups.
The SNIS and Get Ahead of Stroke campaign have contributed a great deal to improving US stroke transport and triage recently. What do you think the priority should be in this space moving forward?
We must continue to bring attention to the importance of patients’ access to lifesaving thrombectomies. If we do not ensure local and state-wide initiatives emphasise prehospital screening and triage, our communities will suffer from continued inadequate access.
What is your proudest achievement to date in the neurointerventional space?
I hope that, should anyone ever look back on my career, they will understand that I sought to bring our community together for the betterment of our patients. When I began my career, many of our constituent physicians were siloed according to their background specialty, and our respective societies were often at odds. I have worked to build bridges across these different training backgrounds, so that we all work together as neurointerventionists to advance the field. The level of coordination and collaboration that exists today is so much greater than we had even 15 years ago. I am proud to have made meaningful contributions towards bringing the field together, and I believe the SNIS—as a truly multidisciplinary society—is an ideal society to help affect such changes.
What do you feel has been the most important development in this field during your career?
The invention, improvement, and eventual widespread adoption of stroke thrombectomy has been, by far, the most important development in this field to date. The abilities to embolise aneurysms, or open blocked carotid arteries, or cure dangerous fistulas, have all been tremendously important, but none of those developments have so dramatically affected humanity’s health as stroke thrombectomy. We are now moving into a future where neurointervention will possibly facilitate brain-computer interface and, if successful, then that development may be of a magnitude to rival the benefit provided by stroke thrombectomy.
Could you name the one technology or advancement that you think neurointerventional care stands to benefit from the most?
There are so many exciting technologies and potential advancements on the horizon. But, as I mentioned, I believe our field and humanity itself may be most positively affected by the advent of transvascular brain-computer interface technology.
With so much focus being placed on thrombectomy, is there a risk that other areas may become slightly neglected?
There is always a risk that, when one area dominates in terms of resources and attention, that the other areas might suffer. I believe that it is one of the most important jobs of the SNIS to ensure this does not happen, and that patients still receive their aneurysm care by physicians with appropriate training and expertise, or technological progress continues to occur for patients with carotid disease, brain arteriovenous malformations and other diseases. As the field grows, and new diseases are treated successfully with neurointerventional techniques every year, we must ensure patients are not cheated out of this progress because one area of the field drowns out the rest.
“I hope that, should anyone ever look back on my career, they will understand that I sought to bring our community together for the betterment of our patients.”
Could you describe one memorable case and what you learned from it?
I had a case once where, during balloon remodelling, the intracranial carotid artery ruptured. I thought for sure it would result in the patient’s death, but I quickly managed things the best I could and took several steps to try and get the patient through this horrible complication. It was very harrowing, and it took us a while, but we got him back to his life. It has been eight years from that surgery and the patient has no neurologic deficits. I am sure much of his good fortune is due to things that were not under my control, but this case reminds me that nihilism has no place in this field. We can be amazed at the outcomes patients can achieve, if we are willing to put in the time and effort—and a little luck, or fate, comes into play.
What are your interests outside of the field of medicine?
My primary interest outside of work is, by far, my family. I have a wonderful wife, Wendy, who is a lawyer by trade and the heart of our family. We have three rambunctious boys—Finn (14), Michael (13), and Conall (10). My mother, Ruth, lives with us too. It is a wonderful, nuclear family, and we also have a rich extended family who visit often. I try to spend all my free time with my family. I serve as a wrestling coach on my kids’ youth teams and driving them around to their activities is one of my favourite ways to spend time. I grew up playing the trumpet and still very much enjoy music. I wrestled in high school and then played rugby a great deal during my late teens through my early 30s, playing the position of inside centre for the South-Eastern US Select Side champions in my senior year in college, and captaining the Columbia Physicians and Surgeons (P&S) ‘Doctor Warriors’ while in medical school. I had a brief flirtation with fame when a photo of me playing rugby was used as the cover image for Delta Sky Magazine. However, it turns out my face is better suited for radio, as that was my first and last magazine cover.
- 2019–present: Kalmon D Post Professor and senior vice chair, Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai (New York, USA)
- 2014–2022: Professor, Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai
- 2012–2014: Associate professor, Departments of Neurological Surgery and Radiology, Vanderbilt University (Nashville, USA)
- 2009–2011: Assistant professor, Departments of Neurological Surgery and Radiology, University of Florida (Gainesville, USA)
- 2007–2008: Fellow, Endovascular Neurosurgery, University at Buffalo (Buffalo, USA)
- 2004–2007: Master of Science, Biostatistics, Mailman School of Public Health, Columbia University (New York, USA)
- 2002–2007: Resident, Neurological Surgery, The Neurological Institute of New York
- 1995–2000: Doctor of Medicine, Columbia University College of Physicians and Surgeons
- 2022–2023: President, Society of NeuroInterventional Surgery (SNIS)
- 2019: First Place Abstract, Congress of Neurological Surgeons (CNS) annual meeting
- 2011: Exemplary Teacher Award, University of Florida College of Medicine
- 2005: Outstanding Research Award, New York Society of Neurosurgery