1. NCEPOD Managing the flow SAH Report Launch 22 Nov 2013
Interventional Neuroradiology (INR) (Endovascular therapy EVT) Dr John Millar MRCP FRCR UKNG/BSNR
Wessex Neurological Centre UHS

2. Aneurysm Coiling
GDC coil introduced UK 1992

3. Aneurysm Coiling GDC coil introduced UK 1992
ISAT – mcRCT, 1997-Sep 2002

4. Aneurysm Coiling GDC coil introduced UK 1992
ISAT – mcRCT, 1997-Sep 2002
2143 pts – NS Clip vs EV Coil

5. Aneurysm Coiling GDC coil introduced UK 1992
ISAT – mcRCT, 1997-Sep 2002
2143 pts – NS Clip vs EV Coil
7.4% (p=0.0001) ARR of death
or yr - coiling

6. Similar findings RT’s:
Aneurysm Coiling
GDC coil introduced UK 1992
ISAT – mcRCT, 1997-Sep 2002
2143 pts – NS Clip vs EV Coil
7.4% (p=0.0001) ARR of death
or yr - coiling
Similar findings RT’s:
Kuopio (109)
BRAT (471)

7. Audit data UK rates of coiling by centre type September 2001 – April 2002 Based on returns to Royal College of Surgeons Langham J et al Stroke 2009
Large recruiting ISAT centres(> 50 pts 12)
n = 660
Low recruiting ISAT centres (50 pts 9)
n = 297
Non ISAT centres with coiling (5)
n = 196
N = 1362

8. Audit data UK rates of coiling by centre type – January 2003 – September 2003 Based on returns to RCS
Large recruiting ISAT centres n = 431
Low recruiting ISAT centres n = 171
Non ISAT centres with coiling n = 85
N = 775

9. Service Reorganisation?
Job planning
Separate directorates of NS and NR
Central work force planning

10. Service ReorganisationX
Job planning
Separate directorates of NS and NR
Central work force planning

11. Service ReorganisationX
Job planning
Separate directorates of NS and NR
Central work force planning
Dual role INR/diagnostic NR

12. 24/7 Diagnostic Neuroradiology
Urgent Imaging (CT/MRI)
Head injury/depressed GCS
Stroke & TIA
Cauda equina syndrome
24/7 MRI
Development of trauma centres

13. 24/7 Diagnostic Neuroradiology
Urgent Imaging (CT/MRI)
Head injury/depressed GCS
Stroke & TIA
Cauda equina syndrome
24/7 MRI
Development of trauma centres
7/7 consultant led working in Neuroradiology

14. Neuroradiology workforce UK
NR’s MR CT
Angio Rx
2001
3.75 % 25 50 20 30
>400 ?
2009
4.75
WTE
34 Neuroscience Units, UK
Source: BSNR, Safe Neuroradiology 2012

15. Neuroradiology workforce UK
2013 : 185 Neuroradiologists (BSNR - 34 NSU)
Approx half undertake INR procedures
NSU’s: 3 INR capable

16. 7/7 Aneurysm Rx? Neuroradiologist expansion – INR/DNR
Team - Neuroanaesthetist, theatre staff, scrub staff, Radiographic
Vascular Neurosurgery ?
Networks ?