Training Standards in Neuroendovascular Surgery: Program Accreditation and Practitioner Certification

Abstract

Representing neuroendovascular surgery physicians from neurosurgery, neuroradiology, and neurology, the above mentioned societies seek to standardize neuroendovascular surgery training to ensure the highest quality delivery of this subspecialty within the United States.

Trends in hospital procedure volumes for intra-arterial treatment of acute ischemic stroke: results from the paul coverdell national acute stroke program

“…This has been demonstrated in the past; however, the definition of a high-volume center varied considerably, ranging from >10 to >50 IATs annually per site 5 7 8. We defined high-volume as >30 procedures per year based on CAST requirements for accreditation of training programs 13. Within the interventional cardiology literature we have learned that the number of high-volume physicians affects the high hospital volume to favorable outcome relationship 23.…”

Stroke patients can’t ask for a second opinion: a multi-specialty response to The Joint Commission’s recent suspension of individual stroke surgeon training and volume standards

“…Initial evidence to support these requirements can be found in the multi-specialty recommendations for training by the Committee for Advanced Subspecialty Training (CAST) 1. These recommendations emphasize the importance of training and experience for achieving optimal outcomes.…”

“…It should be designed to protect them from inherent political or financial considerations that may otherwise affect delivery of ELVO patients to suboptimal facilities. In the absence of appropriate certification pathways, such as those addressing delivery of trauma care, we must strive for:1 transparent, accountable, and evidence-based certification for stroke hospitals as CSC/TCC; and2 recognition of those certifications by Emergency Medical Services (EMS) systems to direct the transport of severe stroke patients directly to certified centers. The evidence is clear that:1 the data to support the performance of thrombectomy for ELVO patients were overwhelmingly generated by specialized high-volume neurointerventionalists;2 there are no data to confirm that these results are applicable to low-volume non-neurointerventionalists;3 stroke center volume is strongly associated with outcome quality;4 practitioner experience with thrombectomy, as well as essentially all surgical procedures, is correlated with outcome quality;5 all three neurointerventional societies, whether the parent organization represents radiologists, neurologists, or neurosurgeons, have agreed on a common credentialing standard for physicians who wish to perform thrombectomy;6 the 2016 CMS, PSPS, and PUF data cited by TJC does not refute the suggested minimums but instead supports them; and7 TJC remains the broadest and most influential organization empowered to protect stroke patients from the proliferation of substandard care.…”

Thrombectomy stroke centers: The current threat to regionalizing stroke care

“…This is based on a thorough understanding of stroke systems of care and numerous studies highlighting the importance of procedural volume 2–5. A recent paper published in Stroke outlined the metrics and criteria for Committee on Advanced Subspecialty Training (CAST) Neuroendovascular Fellowship Certification 6. In this document, the minimum acute ischemic stroke treatment numbers mandatory for each trainee (30), are substantially higher than those required for thrombectomy capable certification (each neurointerventionalist at a TSC needs to perform only 12 mechanical thrombectomies over the previous year) 1.…”