Author: Kevin M. Cockroft, MD
The past few years have seen a dramatic increase in the use of mechanical thrombectomy for acute ischemic stroke. More recently, the advent of new minimally invasive therapies for the treatment of intracerebral hemorrhage (ICH) has led to a renewed interest in the management of ICH. Neurosurgeons were at the forefront of many of these stroke therapies, and the efforts of the Cerebrovascular (CV) Section continue to reinforce the role of neurosurgeons as key players in the management of stroke. The past year, in particular, yielded much progress in various collaborative efforts, as the Section remains active in promoting education, research, and optimal healthcare policy to benefit our patients with neurovascular disease.
The Section's Annual Meeting cycle kicked off at the 2016 CNS Annual Meeting in San Diego, California, where CV Scientific Program Chair Dr. Brian Jankowitz and Co-chair Dr. Stavropoula Tjoumakaris put together a particularly engaging program. Highlights included a vigorous discussion of the pros and cons of various specialties working together in a Comprehensive Stroke Center. Dr. Gary Steinberg of Stanford University gave the Drake Lecture. Drawing on his background as a busy microvascular surgeon with an active NIH-funded laboratory, Dr. Steinberg was able to offer interesting perspectives on the future of our field.
In February, we joined forces with the Society of NeuroInterventional Surgeons (SNIS) for our Annual Scientific Meeting, held in Houston, Texas. We were honored to have the Federacion Latinoamerica de Sociedades Neurocirugia (FLANC) serve as our international partner. Dr. Adam Arthur led the scientific program on behalf of the CV Section, while Dr. Robert James coordinated efforts from the SNIS side. This multispecialty format provided interesting and thought-provoking content. Dr. Robert Harbaugh from Penn State University gave the Luessenhop Lecture, delivering an informative and visionary presentation on an alternative paradigm for collecting and assessing medical evidence.
Also in Houston, the AHA/ASA International Stroke Conference (ISC) immediately followed our section meeting. Again this year, faculty participation by CV Section members far outweighed the comparative size of our relatively small subspecialty. Rounding out the academic year, the CV Section program for the 85th Annual Scientific Meeting of the AANS in April was designed by Dr. Jankowitz and Dr. Tjoumakaris. Dr. Nick Hopkins and Dr. Robert Rosenwasser gave the Yasergil and Donaghy Lectures, respectively.
The CV Section partnered with the Neurosurgery Research and Education Foundation (NREF) to enhance our ability to raise funds and coordinate philanthropic efforts on behalf of research and education in neurovascular disease. In 2016, we were fortunate to receive a generous multi-year donation from Dr. Arvind Ahuja, a longtime CV Section member. Dr. Ahuja's donation helps support a new clinical research fellowship award, the L. Nelson "Nick" Hopkins Young Clinician Investigator Award, which is jointly sponsored by Dr. Ahuja and the CV Section. The award honors Dr. Hopkins, a mentor of Dr. Ahuja's and a prolific clinical researcher, as well as a neurosurgical pioneer in the field of neuroendovascular surgery. The purpose of the fellowship is to support junior faculty pursuing careers as clinical investigators in cerebrovascular disease. The 2017-2018 grant was awarded to Dr. Robert M. Starke, MD, from the University of Miami, who will conduct research on the role of endothelial cell dysfunction and differentiation in aneurysms progression and healing nominations.
The CV Section has also maintained its commitment to the NINDS/Getch Award K12 Award, administered by the CNS Foundation. As a section, our leadership team continues to seek out corporate sponsorship opportunities, as multiple areas within the CV Section will benefit from ongoing financial support. However, for these solicitations to be most effective, it is important for us to demonstrate a robust commitment to the Section by our own members. To this end, I strongly encourage all of our members to make a donation to NREF in support of the CV Section. In order for the CV Section to continue to grow as a force in neurovascular patient care, we must remain leaders in cutting-edge neurovascular research as well as in the education and training of the next generation of neurovascular specialists.
A Comprehensive Neurovascular Data Registry
The NeuroPoint Alliance (NPA), in conjunction with the CV Section, developed a CV module for the Quality Outcomes Database (QOD, formerly known as N2QOD). As of fall 2016, the QOD-Neurovascular was active at 15 sites, and more than 1,400 patients were entered into the database. Discussions are proceeding with the NPA, SNIS, and JCVS concerning the creation of the NeuroVascular Quality Initiative (NVQI), a joint, collaborative registry with the SNIS database. Discussions are also underway with the FDA regarding a possible post-approval acute ischemic stroke device registry.
Stroke Center Accreditation
The Section continues to work with the AHA/ ASA, Joint Commission (JC), DNV-GL Healthcare, Cerebrovascular Coalition (CVC), and Brain Attack Coalition (BAC) to use consistent and appropriate guidelines for the certification of Primary and Comprehensive Stroke Centers. There has been much discussion about the varied standards put forth by different accreditation organizations, and lack of adoption of our previously negotiated standards. The latest action was to be a consensus statement by the CVC.
However, after the American Academy of Neurology (AAN) chose not to join the rest of the members of the CVC in supporting the document, the final statement ended up being submitted to the journal Stroke on behalf the individual endorsing societies. The manuscript is currently being revised based on comments by the journal reviewers.
The Section also remains active in other areas of accreditation, with Dr. Brian Hoh as a member of the AHA's Hospital Accreditation Scientific Committee, and Dr. Nick Bambakidis, Dr. J Mocco, and Dr. Hoh serving as neurosurgical representatives to the Joint Commission's Technical Advisory Panel.
Finally, the CV Section lent its support to the BAC's latest statement, "Revised and Updated Recommendations for Acute Stroke Ready Hospitals, Primary Stroke Centers, Comprehensive Stroke Centers, and Stroke Systems of Care."
Fellowship Training Standards
In a truly outstanding collaborative effort, the Section worked very closely with the Committee on Advanced Subspecialty Training (CAST) of the Society of Neurological Surgeons (SNS), as well as the Society of Vascular Interventional Neurology (SVIN), and the SNIS to develop common training standards for neuroendovascular surgery. A similar neurosurgical effort also helped finalize criteria for "open" cerebrovascular fellowship training standards.
In addition, since September of 2015, CAST has been certifying individuals in neuroendovascular surgery. The first set of individuals' neuroendovascular surgeon applications were vetted at the 2016 CV Section meeting in Los Angeles and a grandfather-system is in place until 2020.
Many thanks as always to our CV Section Executive Committee and our many active members whose dedication and volunteerism allow the CV Section to function at the highest level. Dr. Greg Zipfel will follow me as Section chair, and with his leadership, a new strategic planning process is already underway to ensure that the CV Section is well positioned to meet the various challenges that lie ahead.
We are fortunate to be members of a dynamic and exciting specialty, but it behooves us all to remain engaged so we may continue to advocate for, and subsequently deliver, the best possible care for our patients.