LAUSR

The field of neurointerventional radiology (NIR) has exponentially grown in recent years. This includes dramatic advances in the care of acute ischemic stroke because of large vessel occlusion, technological advances in the treatment of intracranial aneurysms, and innovative improvement of embolization techniques. These hard-won victories were fought by neurologists, neurosurgeons, radiologists, and interventionalists. But as the neurointerventional radiology (NIR) field expands, how can its provider supply keep up with demand? Clearly, this expansion is across the gamut of vascular neurological disease. Historically, most interventionalists were radiologists or neurosurgeons. Recent data suggest that these proportions may be shifting, with NIR practitioner backgrounds including a substantial amount of neurologists.1 Neurologists have an invaluable perspective to offer as they provide care across the entire spectrum of vascular neurological disease, witnessing natural history and outcomes first-hand. Interventional neurologists can facilitate improved access to care across the spectrum of vascular neurological disease, particularly as many patients with NIR care needs may be initially seen by neurologists. As systems of care expand, increasing access will mean increasing comprehensive and thrombectomycapable stroke centers. The interventional neurologist, with expertise in both medical and procedural care of vascular neurological disease, is uniquely equipped to champion these centers’ development. Yet, despite the value of interventional neurologists, there are structural and cultural barriers that prevent brisk flow through the training pipeline. This article serves to examine said barriers and propose solutions to recanalize the flow of neurology trainees into NIR. BLOCKED FLOW—BARRIERS TO BECOMING AN INTERVENTIONAL NEUROLOGIST