New WIST guidelines seek to improve access and standardise training in stroke thrombectomy

Iris Grunwald (left) demonstrates the use of a surgical simulator

A new set of guidelines intended to standardise and expand stroke thrombectomy training have been published simultaneously in Europe, in the journal Advances in Interventional Cardiology, and in the USA, in Cardiovascular Revascularization Medicine.

The World Federation for Interventional Stroke Treatment (WIST) guidelines for multispecialty endovascular stroke intervention are intended to help develop specific training modules across a wide range of scenarios, including complications, and to facilitate standardised training. A primary goal of the guidelines is to improve patient access to thrombectomy by expanding the range of specialties that can perform these procedures beyond interventional neuroradiologists (INRs) to include clinicians from varying, relevant backgrounds.

A recent University of Dundee (Dundee, UK) press release notes that—despite its proven effectiveness in treating acute stroke caused by large-vessel occlusion—a small proportion of patients actually receive a thrombectomy in many parts of the world. One of the major constraints to expanding thrombectomy services is the inadequate number of INRs able to perform them.

“When I first experienced the power of endovascular stroke treatment, now nearly 20 years ago, I realised this treatment was here to stay,” said Iris Grunwald (University of Dundee, Dundee, UK), lead author of the guidelines and vice president of WIST, who is an advocate of cross-specialty and multidisciplinary collaboration in stroke care.

“On the one hand, we needed more interventionists to cover a worldwide demand; on the other hand, it would not be feasible to ‘produce’ thousands of extra INRs. The number of other neurointerventional cases is just too small. That is when I started advocating cross-specialty training. The manpower of cardiologists and radiologists is much greater, and most hospitals already have angiographic services that would allow incorporating endovascular stroke treatment without much additional infrastructure.”

The new WIST guidelines focus on competency—rather than time-based training—promoting the use of high-fidelity simulation training and unique, perfused cadaveric models to help clinicians acquire both operator as well as team skills.

Training according to WIST guidelines using these innovations in the University of Dundee’s School of Medicine—now accredited as WIST’s official global training centre—has already allowed the setup of successful thrombectomy services in Argentina, Poland, the UK and additional sites. These training protocols are increasingly being adopted worldwide to tackle the global healthcare challenge of stroke and increase the number of interventionists performing endovascular stroke treatments.

One example of the simulation technologies being deployed here is ANGIO Mentor (Simbionix), which incorporates modern recanalisation techniques, such as carotid revascularisation, intracranial stenting, and mechanical thrombectomy via stent retrieval or aspiration, but also plays a role in complication and team training, as well as decision-making.

“Simulation training is a crucial part of the WIST guidelines, since it is the best way to train and assess physicians and teams in this emergency procedure without risking patients’ lives,” Grunwald stated. “Simbionix’s ANGIO Mentor specifically provides the most realistic proficiency-based training—allowing physicians to prepare for unexpected complications that may arise during the intervention.”

The guidelines, which have been produced in conjunction with other leading figures from the fields of neuroradiology, interventional neurosurgery, stroke neurology and cardiovascular medicine, are designed to map out a training and credentialling pathway for interventionists so that doctors and teams from relevant specialities looking to train in endovascular stroke treatment for WIST accreditation will be able to do so. They offer personalised training to achieve standardised learning outputs, enabling doctors to perform cerebral angiograms, carotid stenting and endovascular stroke treatments safely, the release also notes.

“This development is of great significance to healthcare professionals, stroke associations, governments, healthcare services and, ultimately, patients and their families,” Grunwald added. “Despite some important differences in the vessels and organs, many of the techniques involved in endovascular stroke treatment, including thrombectomy, angioplasty and stenting, are familiar to the interventional radiologist and cardiologist. However, while technical nuances can be easily learned by skilled interventionists, WIST emphasises the importance of team training and training in pathophysiology, neuroanatomy, image interpretation, clinical examination and decision-making, and the management of complications.”


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