Planning for Nationwide Endovascular Acute Ischemic Stroke Care in the United States: Report of the Interventional Stroke Workforce Study Group

Background: In the United States, regional systems of care for acute ischemic stroke are poised to undergo a major transformation in structure and function, with the imminent launch of Joint Commission certification of Comprehensive Stroke Centers and continued accumulation of evidence supporting the use of endovascular recanalization therapy for select patients. Methods: A Study Group was convened of leading endovascular neurointerventionalists and stroke neurologists. The group reviewed available data and multispecialty perspectives to develop projections and recommendations for workforce, infrastructure, and policy modifications to insure acute ischemic stroke patients have access to endovascular recanalization therapy and the appropriate levels of care.Results: The frequency of performance of acute endovascular recanalization therapy (ERT) interventions is projected to at least quadruple, from 14,000 in 2008 to more than60,000 annually in coming years. To deliver ERT, 200-300 Comprehensive Stroke Centers with neurointerventional capability are desirable in the United States. Professional workforce needs are projected at 600-900 practicing neurointerventionalists, with an average case volume of 70-100 cases per year. Recommendations are provided for EMS and hospital interactions within regional systems of care, state and county analyses of neurointerventional center needs, professional society consideration of potential modest training program expansion, public education, completion of randomized clinical trials and econometric analyses, development of CPT codes for neurothrombectomy, refinement of patient selection by clinical features and penumbral imaging, neurointerventionalist relationship-building with Emergency Department staff, and sharing of best practice models