Endovascular interventional neuroradiologic procedures: who is performing them, how often, and where? A survey of academic and nonacademic radiology practices.

BACKGROUND AND PURPOSE In this report, the authors assess practice patterns at both academic and nonacademic centers regarding the treatment of aneurysms with Guglielmi detachable coils (GDCs), thrombolysis of the carotid-vertebral arteries, and stent placement with angioplasty of the carotid arteries. METHODS A neurovascular radiology survey was sent to 102 directors of neuroradiology fellowship programs in the United States and Canada ("academic centers"). The survey was also sent to senior members of the American Society of Neuroradiology (three per state) who were not affiliated with fellowship programs ("nonacademic centers"). RESULTS Fifty-seven surveys from academic practices and 70 surveys from nonacademic practices were returned. A total of 4361 procedures (2283 GDC; 949 thrombolysis; 1129 stent placement) were performed; 84% were performed at academic centers and 16% at nonacademic centers. Ninety percent of GDC, 71% of thrombolysis, and 82% of stent placement procedures were performed at academic centers. Seven academic and three nonacademic centers performed 48% of all GDC procedures; eight academic and four nonacademic centers performed 45% of all thrombolysis procedures; eight academic centers performed 50% of all stent placement procedures. A total of 544/4361 (12%) procedures were performed by nonradiologists. At academic centers, 14% of procedures were performed by nonradiologists; participation by nonradiologists was greatest for carotid stent placement (24% of procedures). At nonacademic centers, only 5% of procedures were performed by nonradiologists. CONCLUSION According to this survey, most endovascular interventional neuroradiologic procedures are performed at academic centers; given the survey population, this study likely identifies the lower limit of participation by nonradiologists (12%). Performance of these procedures is concentrated in relatively few centers, and these data raise questions about the overall use of intraarterial thrombolytic therapy for acute infarction.