Over the past few years, the landscape of stroke care has changed dramatically due to technological advances and increased possibilities to train on endovascular procedures.
I spoke to Dr. L. Nelson Hopkins, also affectionately known as The Godfather of Endovascular Neurosurgery, about the future of stroke care, challenges and barriers, and why simulation will play an important part.

Hi, Dr. Hopkins. You are the MD Chief Scientific Officer at the Jacobs Institute in Buffalo, New York. What do you do at the Jacobs Institute?

We are a major multidisciplinary vascular center that includes cardiology, vascular surgery, radiology, and neurology. The Jacobs Institute is our intervention and training center, which lies between our clinical vascular center and major university research center. The Jacobs Institute is tailored to the educational needs of the medical community and the medical device industry. We offer simulation training using Mentice’s equipment for students, engineers, and physicians to learn about endovascular procedures and improve their surgical skills. We also offer industry staff and entrepreneurs to test new medical devices and train on our simulator.

In what ways do you use Mentice’s simulator?

We are doing two things with the Mentice simulator; we use it for training and for developing new products. The simulator gets a lot of use and exposure - in the training process, we expose about four hundred individuals to the Mentice simulator each year; engineers, company personnel, and people who are interested in simulation. We give them the opportunity to learn about simulation and do hands-on training. Several Mentice simulators have actually been purchased based on people seeing what they saw in our intervention center and realizing the advantages of using a simulator.

Technology seems to develop rapidly in the medtech field. How has the landscape of stroke care changed over the years?

Yes, we now know that the interventional treatment of stroke, using clot retrievers and aspiration to remove the clot that causes stroke, is the accepted best way to treat stroke. That means stroke intervention will grow dramatically over the next decade. Today, IV rtPA is still used for mild strokes. But for any major stroke, the standard of care is actually to go with catheter-based intervention to the spot of the clot and remove it mechanically. The main advantage of endovascular methods is that removing the clot restores the blood flow immediately to the affected brain tissue, whereas medical management does not. And the whole key to success when treating a stroke is removing the blockage so that you can restore blood flow to the brain.

What are the challenges in neurointervention for treating stroke today?

I think one of the problems we face, is that there are 15 million strokes in the world every year. And we don’t have the manpower in neurointervention to be able to treat all those strokes. In addition, we don’t have the manpower in position, so most of the strokes occur outside of major neuro centers, where there is interventional cardiology, neurosurgery and radiology but there may not be neurointervention. So I think, the important thing is to treat the stroke by reopening the artery as quickly as possible to revascularize the brain. And if you think about it, the only way we can do that on a larger scale, is to take advantage of the training programs that exist all over the world.

Can or should non-neurointerventionalists be trained to treat stroke?

Yes, any specialist who is an expert and user of catheters to remove clots from obstructed arteries would be a good candidate to learn about stroke intervention. They would require training, but once somebody who is skilled in intervention on other parts of the body, learns the anatomy, the path of physiology, and the fragility of the cranial vessels, I think other interventionalists are certainly fair game for treating acute stroke. That could include cardiologists, interventional radiologists, or even some endovascular surgeons.

What possibilities are there for cardiologists and other physicians to get properly trained in stroke treatment?

Right now, there are relatively few training programs for cardiologists and other physicians. Finding ways to create training programs for them, may be one of the biggest barriers that we face. But I think that simulation will have a major importance in training cardiologists, interventional radiologists, and endovascular surgeons around the world to treat stroke quickly using interventional procedures.

Thank you, Dr. Hopkins, for providing your knowledge and interesting perspective on the future of stroke care!

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