Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention

Abstract

Appropriate and adequate cognitive and technical training, proficiency and experience are essential for the safe performance of procedures that confer significant risk to patient well-being. This principle is the foundation of all medical education and is especially important when considering the cerebral vasculature, for which stroke is a defined risk for every endovascular procedure. Despite recent advances in noninvasive diagnostic neuroimaging, diagnostic cervicocerebral angiography remains the cornerstone and "gold standard" for the evaluation and treatment of patients with cerebrovascular disease.1 In addition to a high level of technical expertise, performance and interpretation of diagnostic cervicocerebral angiography requires in-depth cognitive knowledge of related neurological pathophysiology, neurovascular anatomy and pathology, and an understanding of the full range of neurodiagnostic possibilities. Expert diagnostic cervicocerebral angiography is the foundation for safe and successful cervicocerebral endovascular intervention, including carotid artery angioplasty and stenting for atherosclerosis, interventional stroke therapy, intracranial angioplasty and stenting, and embolization of cerebral aneurysms, epistaxis and vascular malformations. All of these procedures are increasing in volume and complexity with recent technological advances that further mandate the need for adequate cognitive acumen and technical skills. To ensure proper outcomes, formal neuroscience training, adequate procedural training and sufficient experience are all essential for competency in diagnostic cervicocerebral angiography and interventional procedures, including carotid stenting. These concepts have been delineated in training requirements by the Accreditation Council for Graduate Medical Education (ACGME) and by previously published official society statements. The purpose of this document is to define the minimum training and See also page 188 *These organizations represent all clinical medical specialties with formal accredited ACGME-approved training in the cervicocerebral vasculature and associated neurological pathophysiology. The executive committees and governing bodies of each organization have approved this document. †Authors/reviewers for the NeuroVascular Coalition Writing Group are listed in the Appendix.

Vascular Imaging in Stroke: Comparative Analysis

“…Limitations of DSA include its operator dependency and availability because cerebral angiography requires specific and intensive training (Table 2) [71]. However, the future progress of stroke care lies in the establishment of hub-andspokes networks to reach the population of patients with established reperfusion therapy, such as tPA and to aid the transfer of patients in need of comprehensive stroke care [44] to the centers with subspecialty trained clinicians.…”

Efficacy Of Three-dimensional Contrast-enhanced Magnetic Resonance Angiography (3d Ce-mra) In The Diagnosis Of Thoracic Outlet Syndrome

“…Although this method provides the highest resolution in all of imaging modalities currently available, it is an invasive procedure and has a lower but considerable complication rate. Other disadvantages of the method are contraindication in allergic cases, nephrotoxicity of contrast material, and ionizing radiation (26,29). As arterial and venous compression findings present intermittently, the pathology could not be depicted during angiography.…”

S3-Leitlinie Extracranielle Carotisstenose

“…Erfahrene Untersucher haben bis zu 6-mal niedrigere Komplikationsraten als unerfahrene. Analysen der Lernkurven deuten an, dass etwa 200 Untersuchungen notwendig sind, um eine ausreichend niedrige Komplikationsrate zu erzielen [90].…”