Richard P Klucznik currently serves as the president of the Society of NeuroInterventional Surgery (SNIS) and the director of interventional neuroradiology at The Methodist Hospital (Houston, USA). Here, he talks to NeuroNews about his experience treating stroke throughout COVID-19, how the society has had to quickly adapt to deliver education, and the lessons learnt from the pandemic. Despite the upheaval in healthcare during this time, Klucznik argues that the future for the field of neurointerventional medicine, in general, looks bright. “There will be a world where no aneurysm cannot be treated by using minimally invasive techniques, and no thrombus will stay inside a blood vessel causing a stroke,” he says.
What first attracted you to the field of neuroradiology?
It was during my radiology residency when magnetic resonance imaging (MRI) first came to the forefront of imaging and we could see brain and spine like we never could before. The radiology residency programme was affiliated with the University of California at San Francisco and we were invited to the Thursday neuroradiology conferences. It was at that time that I was first introduced to interventional neuroradiology where Grant Heishima was giving grand rounds; I knew from then that I was interested in interventional neuroradiology.
Have you had important mentors throughout your career? What have they taught you?
One of my first mentors was Dr Samuel Wolpert, who epitomised the word gentleman. He received a gold award for his work in the field of neuroradiology. He knew the vascular anatomy of the brain better than anyone I have ever met. Other teachers I have had include Drs Eddie SK Kwan and Michel Mawad. My partner Dr Orlando Diaz is a mentor to many and I have learnt a lot from him, and I believe him to be one of the smartest neurointerventionalists. I consider him a good friend, partner, and mentor.
Other members have not only taught me a skill set that is necessary for interventional neuroradiology, but how to treat patients properly as human beings and their family members who are so intimately involved in their care.
What has your experience as president of SNIS been like amid COVID-19?
My experience as president of SNIS amid the COVID-19 pandemic has been quite interesting. Since all travel was banned, I was not able to represent the SNIS at other meetings across the world, and everything became web-based. We learnt quickly how to adapt with webinars and the upcoming annual meeting will also be web-based. We naturally could not hold an in person board meeting as well. Sadly, it is the personal relationships that have been sacrificed because it is important to make lasting friendships and to pass the torch to the incoming president and vice president.
How has the pandemic changed the society’s approach to delivering education?
The pandemic has certainly changed the society’s approach to delivering education. We have become totally web-based and are now giving weekly webinars for our society members. We do not know when we will have an in person meeting in the future, hopefully next year at the Broadmoor Hotel in Colorado Springs.
Can you tell us about your experience practising as a physician during COVID-19? Have you had to make any difficult clinical decisions?
During the pandemic we have learnt how to wear personal protective equipment (PPE) that we never had to wear before with multiple layers, facemasks, and N95 masks. It seems we learnt that stroke patients may not be making it into the hospital for fear of the virus and we have begun a programme to reach out to patients to reassure them that we are here to treat them. Early on we were not sure which patients may have the virus so we were treating all incoming strokes as if they were infected. We have now learnt with more testing that we do not have to go to a full extent on a daily basis unless we know that they are infected.
What positives do you see coming from the pandemic in terms of lessons learnt?
One positive I can see from the pandemic is the fact that we have adapted to a new world and learnt to treat infected patients while ensuring we ourselves, and our staff, are safe. We were in the process of building a new hospital with new angiographic equipment and new rooms. We now have to re-examine those plans and instead of routine interventional rooms we must plan for negative pressure rooms in order to deal with the virus in the future.
I think telehealth is also one of the big winners of this pandemic. Already our neurologists were “seeing” stroke patients from other hospitals via telemedicine and all of us are working to “see” patients and consult via the web.
As far as other things we have learnt from the pandemic, I think masks will be the new norm for quite some time. We are also learning more about how to fight the virus; some medications seem to be working, such as steroids and maybe remdesivir. However, we need to start returning to normal soon, as patients may not be treated for stroke or heart attack; cancer screening is down and there is a toll that is not being talked about concerning a rise in suicide and drug abuse, as well as spousal or family abuse.
What has been the most important development in the neurointerventional field during your career?
I have seen the neurointerventional field grow from its infancy, not just in devices but in personnel. Of course, the most important development of all was the development of platinum coils that can be placed in aneurysms; now they can be treated using minimally invasive techniques instead of craniotomy.
One of the newest developments is the devices for the removal of clots in emergent large vessel occlusions (ELVO). These have drastically changed the landscape, not just for the people who perform the procedures, but also for the millions of patients that we can now help on a daily basis by treating their acute stroke in a timely manner and then allowing them to recover. The use of new devices such as these has truly revolutionised the treatment of stroke.
On the contrary, what has been the biggest disappointment?
Before the advent of the thrombectomy devices, the biggest disappointment was the devices that came before and did not work, but now that has been completely changed.
We have adapted to a new world and learnt to treat infected patients while ensuring we ourselves, and our staff, are safe.”
What technological advances do you see shaping stroke treatment over the next 10 years, or beyond?
The technological advances in stroke treatment will come through new devices that allow us to get to the clot quicker, as well as more distal devices. The advent of stem cell treatments for stroke will also be a game-changer.
What advice would you give to those beginning their neuro career?
My advice for those beginning their career in the neurointerventional field would be to learn from the past and look to the future, as it is very bright. There will be a world where no aneurysm cannot be treated by using minimally invasive techniques, and no thrombus will stay inside a blood vessel causing a stroke. There may be a need for some specialisation for those to only perform stroke treatments due to the volume, and not necessarily do the rest of neurointerventional procedures.
Outside of medicine, what are your hobbies and interests?
Outside of medicine, my hobbies include downhill skiing, trying to learn how to play golf, and shooting. Since my father fought in World War II in North Africa and Italy, my son has developed an interest in World War II history, and we have begun collecting firearms from the war, such as an M1 rifle that we can take to the range and actually fire at targets.
It is amazing that our soldiers in the past carried weapons that not only were heavy but had a heckuva kick and only had eight rounds. We owe all of our veterans of World War II a great deal of thanks. I am also reading the Bible for the first time in my life thanks to the influence of my wife, Nina. We also love to travel but obviously due to the pandemic that has been put on hold.
