World Federation for Interventional Stroke Treatment (WIST) multispecialty training guidelines for endovascular stroke intervention

Abstract

Introduction: Today, endovascular treatment (EVT) is the therapy of choice for strokes due to acute large vessel occlusion, irrespective of prior thrombolysis. This necessitates fast, coordinated multi-specialty collaboration. Currently, in most countries, the number of physicians and centres with expertise in EVT is limited. Thus, only a small proportion of eligible patients receive this potentially life-saving therapy, often after significant delays. Hence, there is an unmet need to train a sufficient number of physicians and centres in acute stroke intervention in order to allow widespread and timely access to EVT.Aim: To provide multi-specialty training guidelines for competency, accreditation and certification of centres and physicians in EVT for acute large vessel occlusion strokes.Material and methods: The World Federation for Interventional Stroke Treatment (WIST) consists of experts in the field of endovascular stroke treatment. This interdisciplinary working group developed competency -rather than time-based -guidelines for operator training, taking into consideration trainees' previous skillsets and experience. Existing training concepts from mostly single specialty organizations were analysed and incorporated.Results: The WIST establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in EVT. WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models.Conclusions: WIST multispecialty guidelines outline competency and quality standards for physicians and centres to perform safe and effective EVT. The role of quality control and quality assurance is highlighted.

Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning

“…WIST are using their guidelines and establishing clinical knowledge and procedural skills to raise the capability requirements of interventionalist to perform endovascular stroke intervention. 34 Likewise, collaborate with ANGELS Academy provide e-learning program for stroke care knowledge and skills is potential to enhance the competency of neurointerventionist. 35 Providing a proctoring session to the fellow via telemedicine can increase the rate of IVT in many hospitals.…”

Making endovascular stroke treatment possible: training to save brains (and lives)

“…The training requirements should be based on skills; medical specialty should be of no importance. Indeed, physicians of various specialities experienced in endovascular procedures have long demonstrated that they can gain additional knowledge and training to perform EST and be an extremely valuable part of this developing system [ 12 , 13 ]. The required time for diagnostic neuroradiology training is 12–24 months (on top of years of radiology training), and for interventional neuroradiology it is 12–30 months [ 14 – 23 ].…”

“…Embolization of arteriovenous malformations or spinal angiograms are not part of EST. The WIST guidelines [ 12 , 13 ] present an important evolution, encompassing an individualised approach to operator training. An interventionalist experienced in carotid stenting has already acquired an essential part of the skillset required for EST.…”

WIST guidelines: a global solution to increase interventional stroke treatment

“…An agreement was reached with the General Medical Council and the UK Royal College of Radiologists that experienced clinicians who are not interventional neuroradiologists could -and should -undertake training to equip them with the skills to undertake thrombectomy alone, based on pre-existing knowledge and skills (such as advanced intra-arterial catheter skills). By mapping out a training and credentialing pathway for interventionalists from varying backgrounds, WIST guidelines [4,5] finally provide a truly collaborative, competency-based, global solution for increasing the number of endovascular stroke treatments for eligible patients with acute ischaemic stroke [6][7][8][9][10][11][12][13][14][15][16]. The WIST training and credentialing strategy has already been effective in different healthcare systems across the world and, more recently, in Scotland, where safe and effective training according to WIST guidelines has been established.…”