The Role for Cardiologists in Stroke Intervention.

Even though cardiovascular disease (CVD) is still the leading cause of death in the United States, stroke is the second leading global cause of death behind CVD. In the 21st Century, less than 40% of overall stroke patients are discharged to home and almost 25% of Medicare beneficiaries do not survive 90 days. In spite of the fact that tissue plasminogen activator (TPA) has been approved for stroke care for 20 years, only .75% of annual strokes are actually treated with intravenous (IV) TPA. Similar to how interventional cardiologists evolved from IV to catheter mechanical treatment for acute myocardial infarctions (AMI) over 30 years ago, over the last few years, neurointerventionists now perform endovascular stroke therapy in many of these patients using stent retrievers. However, very few stroke patients are actually getting treatment, and neurointerventionists on an average perform only 8 stroke interventions per year. It has been recently shown that 9 out of 10 strokes can be prevented by controlling CVD risk factors. A principal job for cardiologists is to recognize and manage these CVD risk factors in addition to being involved with performing intervention. Atrial Fibrillation is certainly a common problem in all of our practices and puts people at five-fold higher risk of stroke. Cardiovascular cardiology teams already have 24/7 coverage for acute interventions for AMI in place at their facilities. A number of groups have replicated acute stroke care performed by cardiologists at centers worldwide with outstanding results. It makes sense that we try to build a collaboration among neuroradiologists, interventional cardiologists and perhaps vascular or neurosurgeons with expertise in acute endovascular procedures to develop programs for acute and active 24/7 stroke care similar to systems for primary angioplasty for AMI.