Zack Nigogosyan, MD, PGY3 Mallinckrodt Institute of Radiology
Neurointerventional Radiology as a Career
Neurointerventional radiology is a dynamic profession intersected by the fields of radiology, neurosurgery and neurology. Innovations in this profession continue to push the boundaries of treatment possibilities beyond what was even thought to be possible just a few short years ago. As a testament to this, over 65% of cerebral aneurysms are now treated with endovascular therapy rather than open surgery1.
Neurointerventional radiology offers an opportunity to provide an incredibly rare skillset to help your local community. Stroke is one of the leading causes of serious long-term disability in the United States2, and yet many parts of the U.S. remain underserved in their ability to access prompt thrombectomy. Neurointerventional radiology allows us to join the fight against stroke and has the potential to reduce time for revascularization and improve patient outcomes.
There are many paths to becoming a neurointerventionalist, including neurosurgery, neurology, diagnostic and interventional radiology. The radiology path provides distinct advantages. One such advantage is the ability to build a strong background in diagnostic imaging, such as standard cerebrovascular imaging, as well as promising advanced imaging, including vessel wall MRI and quantitative MRA, among others.
This allows you to not only develop an excellent understanding of imaging anatomy, but also to translate imaging findings into pathology and potential treatment. Transformational trials in neurointervention such as MR CLEAN3, DAWN4 and DEFFUSE5 had inclusion criteria that relied on imaging biomarkers for patient selection. To practice evidence-based medicine, understanding how to extrapolate the studied cohort to your own patient is paramount. Therefore, having a deep understanding of imaging biomarkers is a distinct advantage for the radiology-trained neurointerventionalist.
Deciding on neurointerventional radiology was not a straightforward path for me. As with most medical students, experiences within the niche field of neurointerventional radiology was not readily available. I had initially been interested in both radiology and neurosurgery. I was lucky to complete two neurosurgery sub-internships during my final year in medical school. I also performed research in neuroradiology.
Neurointerventional radiology provided an option to bridge my passion for diagnostic imaging with minimally invasive therapies. During medical school, I was also fortunate to find a mentor who practiced both open and endovascular neurosurgery. He introduced me to his incredibly broad practice, and I was able to assist in stroke intervention, arteriovenous malformation embolization, dural venous stenting and other typical interventions.
In residency, I established another mentor in this field and began developing skills under his tutelage, such as arterial access and basic catheter manipulation. In addition to developing clinical skills, I received research opportunities and professional development. Finding mentorship is key to exploring neurointerventional radiology, as there are often few, if any, official established programs available for resident involvement.
Neurointerventional radiology is a very exciting and innovative field; it sets itself as a bridge between the diagnostic and the interventional. Excellence in diagnostic imaging acumen will prepare a trainee with a skillset to provide evidence-based and high-quality care to patients.
- Salem, Mohamed M. and Georgios, A. Maragkos, et al. “Trends of Ruptured and Unruptured Aneurysms Treatment in the United States in Post‐ISAT Era: A National Inpatient Sample Analysis,” Journal of the American Heart Association, February 16, 2021;10, no. 4: e016998.
- Tsao, C.W., Aday, A.W. and Almarzooq, Z.I., et al. “Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association,” Circulation, 2022;145(8):e153–e639.
- Berkhemer, Olvert A., Puck, S.S. Fransen, et al. “A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke,” New England Journal of Medicine 372, January 1, 2015; no. 1: 11–20.
- Nogueira, R.G., Jadhav, A.P. and Haussen, D.C., et al. “Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct,” New England Journal of Medicine, 2018;378:11–21.
- Albers, G.W., Marks, M.P. and Kemp S., et al. “Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging,” New England Journal of Medicine, 2018;378:708–18.