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WHO TREATS ACUTE STROKE AND INTRACRANIAL ATHEROSCLEROSIS?
Multiple physicians with different training backgrounds can be involved in the treatment of acute stroke or intracranial atherosclerosis. The choice of physician depends on many factors, including whether the patient has suffered a stroke (and when), what treatment is considered best for a particular patient, and what physicians are available at the hospital. Not all hospitals have every kind of physician. Some of the physicians that treat intracranial atherosclerosis are described here.
Neurointerventionist
A neurointerventionist is typically a neuroradiologist who is specially trained in endovascular techniques: an interventional neuroradiologist. These are techniques involving inserting catheters into the blood vessels supplying the brain and spine to treat conditions involving these vessels from the inside. These specialists are capable of performing acute stroke therapy and intracranial angioplasty and stent placement, but they are not available at every hospital. A neuroradiologist is a radiologist who specializes in the study of the structures and functions of the nervous system and their surroundings (and the conditions that affect these structures) using techniques such as computed tomography (CT), magnetic resonance imaging (MRI), angiography (inserting catheters into the vessels and injecting dye to study the blood vessels), and ultrasound.
Neurologist
A neurologist is a physician who specializes in the diagnosis and treatment of diseases of the nervous system, typically utilizing a neurological exam as opposed to imaging as described above. Most neurologists rely on treatments that do not require surgery. Traditionally, neurologists have been involved in the prevention of stroke, its diagnosis, and the acute and long-term care of stroke patients. This includes the administration of intravenous clot-busting drugs and other new drugs being tested for the treatment of acute stroke. Recently, a very small number of neurologists have become specially trained in the same endovascular techniques of acute stroke therapy and intracranial angioplasty and stent placement that interventional neuroradiologists perform.
Neurosurgeon
Traditionally, neurosurgeons have specialized in treatment of conditions of the nervous system requiring surgical procedures. They are more likely to be involved in the care of patients with hemorrhagic strokes, especially those caused by abnormalities of the blood vessels supplying the brain, such as aneurysms. However, as the number of conditions affecting the nervous system that can be treated by endovascular techniques has increased, a few neurosurgeons have received training in endovascular techniques. Most of these specially trained neurosurgeons are capable of performing acute stroke therapy. Some of these specially trained neurosurgeons are capable of performing intracranial angioplasty and stent placement.
Interventional Radiologist
An interventional radiologist is a radiologist who has received special training in the use of techniques involving placement of catheters and other devices in blood vessels and other parts of the body using the guidance of x-rays, CT, or ultrasound to treat conditions affecting these structures. Although all interventional radiologists are trained in endovascular techniques, only a few are specially trained in neurointervention. Most of these specially trained interventional radiologists are capable of performing acute stroke therapy. A few of these specially trained neurointerventional radiologists are capable of performing intracranial angioplasty and stent placement.
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