Phil White’s career as a physician and researcher has seen him play a role in numerous major stroke trials, and serve as an educator to many in the interventional neuroradiology (INR) space via the European Course in Minimally Invasive Neurological Therapy (ECMINT). Today, he is the chair of Interventional and Diagnostic Neuroradiology at Newcastle University (Newcastle, UK), and is also currently the only specifically appointed INR professor in the country. Here, White gives NeuroNews an insight into several aspects of his esteemed career and discusses some of the neurointerventional world’s hottest topics.
What initially drew you to medicine, and the field of neuroradiology specifically?
Medicine drew me from my early teenage years for reasons that attract many others—the breadth of the subject, the extensive and fascinating knowledge base, being at the cutting edge of science, and offering a stable career platform whilst also helping people. My involvement in neuroradiology was, to an extent, fortuitous, in that I was very interested in pursuing a career in radiology research and Joanna Wardlaw had recently been appointed into an academic post in Edinburgh, UK as I was coming through radiology training there. Providentially, a Scottish-based neuroscience research fellowship—the Davie Cooper Scottish Aneurysm Study—became available at the right time for me to apply and I was fortunate to be appointed into it. The rest is history.
Who have your mentors been and how have they impacted your career?
Three key mentors stand out for me. Joanna Wardlaw in the fields of neuroradiology and imaging research. Joanna was my co-supervisor for my Doctor of Medicine (MD) thesis and research, and has been an absolute inspiration ever since. If I was a fraction as bright or productive as Joanna, I would be very pleased indeed. Sadly, I am not. In neurointervention, my main trainer was the renowned and inimitable Robin Sellar in Edinburgh. He taught me most of what I know with regard to neurointervention and, above all, Robin made it all great fun, which was fantastic. While he has sadly not been in good health of late, I was privileged to be a colleague of Robin’s for almost 15 years. I also learnt a lot from and was mentored very well by Anil Gholkar in Newcastle, UK, and Anil also subsequently became a work colleague. Anil is totally unflappable, always has time for people, and is an inspirational leader. I have learnt a great deal from Anil and tried to put that into practice in teaching and leadership roles in particular.
Could you briefly outline how you came to be the only current, appointed professor of interventional neuroradiology in the UK?
James Byrne was the first but has now retired. I was the second to hold the title of university chair and professor by appointment, as opposed to the honorary title of professor. After 11 years as a full-time NHS consultant in Edinburgh, my burgeoning research portfolio and activity meant it made sense to move into an academic post in order to be able to maintain and indeed develop that research. After a short period as a reader in neuroradiology at the University of Edinburgh, I took up the position as the first chair of neuroradiology (interventional and diagnostic) in Newcastle in 2012.
How important is the ECMINT course and what makes it an effective educational tool?
ECMINT is a crucial educational tool for European neurointerventionists. It was started by James Byrne and Shelley Renowden in 2013. It takes two years to complete a full cycle of four weeklong intensive courses and offers a comprehensive theoretical knowledge base regarding current neurointerventional practice. Completion of ECMINT is linked to qualifying to sit the European Diploma in Neurointervention (EDNI), which is also linked to the European Society of Minimally Invasive Neurological Therapy (ESMINT). We currently have nearly 150 delegates—70% in person and 30% online, and the great majority are based in Europe, although we do have participants from all other continents except Antarctica. So, over the last 10 years, a considerable number of younger European neurointerventionists have attended it. As it runs in a University of Oxford college over a prolonged period, and we eat and drink together, ECMINT offers them a unique opportunity to make careerlong friends—nationally and internationally—and build support networks and collaborations, including with the distinguished faculty. I really wish something like it had existed in the 1990s when I was training!
What is your proudest achievement to date in the neuroradiology space?
Jointly—and I really cannot put one above the other—it is co-running ECMINT with Shelley Renowden and now with Adam Rennie from London, UK, and co-running the PISTE (Pragmatic Ischaemic Stroke Thrombectomy Evaluation) trial with Keith Muir from Glasgow, UK. Although PISTE had to stop early due to accruing evidence from other trials, we demonstrated that the NHS in the UK could deliver mechanical thrombectomy, with results comparable to other countries, despite no formal investment in it at that stage. This robust, NHS-based trial evidence greatly facilitated the rapid approval of national commissioning of mechanical thrombectomy by NHS England in 2017.
What do you feel has been the neurointerventional field’s most important development during your career?
A decade ago, I would have said ISAT (International Subarachnoid Aneurysm Trial), but now I have to say, unquestionably, mechanical thrombectomy for large vessel occlusion (LVO) stroke—although, without ISAT, I do not think many countries would have had the trained workforce available to deliver stroke thrombectomy!
What is the most pressing unmet need in interventional neuroradiology right now?
We have lots of exciting developments in terms of both techniques and devices, but the key to getting those implemented universally is robust proof. That really means randomised trials or, for some aspects, robust ‘big data’ analysis. There are many things we do that are not truly evidence-based—unruptured intracranial aneurysm therapy for one—and device data are often of very poor quality. There is a balance to be struck between innovation and evidence, and I am not sure we are there yet in neurointervention the way they may be in, say, interventional cardiology.
Which research areas or clinical studies are likely to have the greatest impact on neurointerventional care over the next five years?
Trials in minimally invasive treatments for chronic subdural haematoma (SDH) and primary intracerebral haemorrhage (ICH) are likely to have the greatest impact. Middle meningeal artery (MMA) embolisation could well become another major 24/7 service for neurointervention. I can see neurointerventionists—and in particular those with current/prior neurosurgical practise and training—having an interest in getting involved in minimally invasive ICH neurosurgery, should trials be conclusive in its favour. Whether that means superiority or non-inferiority on primary endpoints, or benefits in terms of key secondary parameters, those upcoming trials could open a door and ultimately expand endovascular treatments wider and wider, as seen in aneurysms and stroke. It is a starting point, but it could herald a lot more activity.
We also hope to obtain robust randomised controlled trial (RCT) data regarding dural venous sinus stenting (DVSS) for idiopathic intracranial hypertension (IIH) in the UK soon, which could lead the way in burgeoning venous neurointerventional practices. Fergus Robertson in London and myself are the co-lead interventional neuroradiologists for an RCT led from Birmingham comparing venous sinus stenting and shunting in severe IIH—we have got the trial up and running, and we are now beginning to recruit patients. A bit like MMA embolisation, if we can show that stenting is as good as shunting but leads to fewer recurrent treatments or is preferred by patients, this is likely to be a foot in the door that leads to stenting being more widely practised. Subsequently, we may obtain evidence to expand DVSS out to a much broader group of IIH patients who have more benign symptoms despite medication, and potentially to other venous indications as well.
How would you assess the impact tenecteplase is set to have on stroke care?
I think what we have seen in our practice is that it is a useful addition, but it is an evolution rather than a revolution—it is a small yet worthwhile advance. The main advantage of tenecteplase over alteplase is that it does not require an infusion, and that is really helpful for speeding up the process in all stroke patients heading for a thrombectomy and particularly in drip-and-ship patients. There are currently issues with the supply of the drug worldwide but, once it becomes available, I think alteplase will largely be confined to the history books in stroke.
What are your thoughts on recent attempts to boost stroke thrombectomy access in the UK by opening the procedure up to other specialties like cardiologists and radiologists?
This has been a frustratingly slow burn. In early 2017, the UK Neurointerventional Group (UKNG), British Society of Interventional Radiology (BSIR) and Royal College of Radiologists (RCR) agreed on a mechanism to train up interventional radiologists in thrombectomy! Uptake in such training has occurred but has been limited by workforce gaps and overstretch. For non-radiologists, the UKNG—including during my time as UKNG chairperson—has supported this in principle, but working through UK General Medical Council (GMC) processes has been very slow and was only finally approved earlier in 2023. However, without dedicated funding and a stronger NHS commitment to INR engagement with it, such training is likely to remain more ad hoc than we would want.
What advice would you give to people embarking on a career in neuroradiology?
- Train in a busy, integrated neurosciences centre that has an enthusiastic neuroradiology team i.e. one that is clearly active in research, teaching, leadership and professional societies
- Train/practise in more than one centre— learning that there is more than one way to do things is important
- If you are training in neurointervention, then attend ECMINT (but I would say that)
- Find a good mentor(s)—ESMINT can help if you need it.
If you required a neurointerventional procedure yourself, who would you ideally want to see leading that treatment?
I think if I required an emergency procedure then I would say Rene Chapot; very good hands, and I think he is also quite lucky! Rene is still very busy and he has such a mass of experience with acute cases. I would probably choose him or Adam Arthur from people who are practising today—but I would want to be awake telling them what to do as well!
What are your interests outside of medicine?
Equestrianism, particularly endurance riding; walking, especially fell-walking; clay pigeon shooting; and my family.
If you had not opted for a career in medicine, what do you think you would be doing for a living today?
I have absolutely no idea except that, if I could have afforded it—which I cannot—being a gentleman farmer seems like a great option!
FACT FILE
Appointments (selected):
- 2012–present: Chair and professor of Interventional and Diagnostic Neuroradiology at Newcastle University (Newcastle, UK)
- 2012–present: Honorary consultant neuroradiologist at Newcastle upon Tyne Hospitals NHS Foundation Trust
- 2000–2011: Consultant neuroradiologist and honorary senior lecturer/honorary reader at University of Edinburgh (Edinburgh, UK)
Education:
- 2002: Research MD with Distinction (University of Edinburgh)
- 1994: MSc in Clinical Imaging (University of Edinburgh)
- 1990: MB ChB with Honours (First Class; University of Liverpool, UK)
- 1988: BSc with Honours (First Class) in Pharmacology (University of Liverpool)
Honours (selected):
- 2020: Presidential Medal, British Society of Neuroradiology
- 2019–2022: Elected Chair, UK Neurointerventional Group
- 2018: Diploma, European Board of Neurointervention
- 2002: Scientific Award, European Society of Neuroradiology
- 1996: Fellowship, Royal College of Radiologists
