And interventional cardiologists have other concerns about the neurovascular guidelines.
For example, the requirement for physicians to complete 100 angiograms could lead to some unnecessary procedures, Kenneth Rosenfield, M.D., director of cardiac and vascular invasive services at Massachusetts General Hospital in Boston and an author of the SCAI guidelines, told CLINICAL NEUROLOGY NEWS.
With the need for diagnostic angiograms declining, some physicians might be inclined to perform the procedure just to satisfy the requirements for performing carotid artery stenting, he said.
Another provision in the neurovascular guidelines that calls for 6 months of ACGME-approved training in the neurosciences doesn't match up with the training of most experienced physicians who are successfully performing carotid artery stenting, Dr. Rosenfield said.
“It should not be about setting barriers,” he said. “It should be about allowing patients access to these procedures.”
And not all the criticism is coming from the cardiology side. Nick Hopkins, M.D., professor and chair of neurosurgery and professor of radiology at the State University of New York at Buffalo, said the guidelines developed by the Neurovascular Coalition lack credibility.
The problem with the guidelines, he said, is that they don't include input from those subspecialties that are performing carotid stenting.
“To make guidelines for others when you don't do it yourself just doesn't compute,” he said.
Dr. Hopkins predicts that hospital credentialing committees will adopt standards closer to those outlined by the interventional cardiologists, vascular surgeons, and vascular medicine physicians because they have the most experience in this area.
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