Do you associate the words heart and stroke. You probably do, because it's a fairly natural association after all, strokes and heart attacks are similar events, both concerning a lack of blood supply to vital organs in the body. Why, then, do completely separate groups of physicians treat heart attacks and strokes. And more importantly, why have ischemic stroke treatment therapies and metrics lagged behind those of the cardiac community. These are the questions that were asked in an under-the-radar session at TCT examining the role that ICs should play when it comes to treating ischemic stroke. It turns out that ICs think they should play a significant role, in fact, there is a movement underway to train ICs in interventional ischemic stroke treatment.
Interventional devices for ischemic stroke treatment have been a buzzy topic over the past year, beginning with the approval of Covidien's Solitaire FR stentriever device, followed closely by Stryker's similar Trevo device. These devices represented a huge leap forward, and now ICs see an opportunity to expand their practices and patient base. Many ICs already do carotid stenting and are involved in other aspects of stroke care and prevention, such as LAA and PFO closure. Treating ischemic stroke itself is simply the next step for these physicians, and could be a positive development both for the US health care system and for medtech companies within the neurovascular embolectomy device market.
In a perfect world, it would make sense for ICs to treat strokes. They already possess the clinical skills necessary to perform transcatheter interventions, and they are an omni-present physician specialty that would provide more patients access to the latest developments in stroke treatment all over the country. The barriers lie in training and turf wars. As one audience member at the session pointed out, it may be hard to ask already-busy ICs to not only learn a new procedure in a foreign area of the body, but also to take on stroke patients in addition to their already heavy patient load. And then there's the question of turf wars. Will interventional neuroradiologists and endovascular neurosurgeons really be willing to give patients up to ICs. Will they even have a choice, Should they?
Despite these barriers, the movement has already started. As long as ICs prove competent, this will end up being a positive development. First of all, more patients will receive quicker access to the best stroke treatment alternatives, hopefully increasing their chances of survival and quality of life post-stroke. The US health care system will benefit because stroke is the #1 cause of adult disability and is extremely costly to the system. Lastly, medical device companies are already pushing this initiative, after all, more physicians in more centers performing stroke treatment therapy translates to increased device sales and higher revenue. In the end, though, it all comes down to the patient. For a devastating event like stroke, quicker access to treatment may be a life-saving development.