Nationwide Care for Acute Ischemic Stroke Patients is Ensured by Radiologists and Neuroradiologists Flächendeckende Akutversorgung von Schlaganfallpatienten durch die (Neuro-)Radiologie ist gewährleistet

2015 marked the beginning of a new age in the treatment of ischemic stroke: Multiple randomized prospective international multicenter studies (MR CLEAN, SWIFT-PRIME, ESCAPE, EXTENDA-IA, REVASCAT) have shown the high level of effectiveness of endovascular therapy, i. e. , minimally invasive removal of a thrombus with the help of a catheter system (stent retriever) under angiographic guidance [1 – 8]. The level of evidence for mechanical thrombectomy with stent retrievers is now 1a and for thrombus aspiration is 2a. The endovascular treatment option thus became the leading evidence-based treatment for severe ischemic stroke (NIHSS ≥ 6 for stroke in the anterior circulation) and is accordingly recommended in national and international guidelines [9, 10]. The current estimate in Germany is 260 000 strokes per year. 80% to 85% of these patients suffered an ischemic cerebral infarction, approximately 25% of which can be systemically treated with rtPA (“recombinant tissue plasminogen activator”). 5 % to a maximum of 10% of all patients with ischemic stroke are suitable for endovascular treatment with mechanical thrombectomy and must reach an appropriate treatment center in time (“time is brain”). We assume that all suitable patients in Germany are able to be treated at certified centers equipped with this treatment option. The consequences of the new evidence are major and include the transition of an individual medical treatment to a recognized treatment method. The next step was to ensure professional training that is integrated in specialist training requirements and thus provides the basis for specialization as an interventional radiologist [11 – 16]. This structured training is ensured in Germany with specialist training in radiology and complementary specialization in neuroradiology. Certification represents a further step in the creation of a quality structure through data collection as performed on a voluntary basis for more than two decades by the DeGIR system developed by the Institute for Quality and Patient Safety (BQS). In the final step, a proven effective treatment must be provided on a comprehensive basis since every patient has a right to receive a recognized disease-specific treatment. This comprehensive care is based on the existing structures of stroke units (17), which are a requirement for interdisciplinary stroke-specific treatment by neurologists, radiologists and neuroradiologists. German neuroradiology, which played an important role in the introduction and clinical development of thrombectomy, was not surprised by the new situation in 2015. The German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society for Neuroradiology (DGNR) have been offering certificates for neurointerventional procedures (modules E and F) since 2012. “Module E”, part of the ongoing series of treatment fields in interventional radiology, includes all vesselopening procedures involving the vessels supplying the brain (extraand intracranial). Mechanical thrombectomy in acute stroke is one of these procedures. 100 interventions, at least 30 extracranial and 30 intracranial, must be documented for certification in Ansgar Berlis Werner Weber Editorial