Program Overview

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Introduction to the Endovascular Surgery Fellowship

The program in Endovascular Surgery at the University of Cincinnati College of Medicine (UCCOM) is focused on the subspecialty that uses minimally invasive catheter-based technology along with radiologic imaging and clinical acumen to diagnose diseases of the central nervous system, head, neck, and spine. This CAST-approved program aims to educate the next generation of Neurointerventionalists by providing a comprehensive program that ensures proficiency and expertise in the skills and judgment required to care for patients with this complex series of diseases.

Goals and Objectives

• Achieve advanced proficiency in the recognition and endovascular treatment of patients with vascular diseases of the nervous system, head, neck, and spine.
• Achieve proficiency in the analysis of issues revolving around patient safety and hospital-based quality improvement in endovascular therapy.
• Contribute meaningfully in facets of education and scholarship in the field of cerebrovascular disease and endovascular therapy.

Length of the Educational Program

This fellowship offers one year of graduate medical education in Endovascular Surgery to those candidates who have fulfilled preliminary criteria. Should the candidate not meet this criteria, a supplementary program shall be offered and require successful completion to a minimum level of competency.

Eligibility Criteria

Neurosurgeons

• Satisfactory completion of a 7-year ACGME-approved residency or be enfolded in the post-Chief Residency year.
• Satisfactory participation in all ABNS CC/MOC requirements.

Neurologists

• Satisfactory completion of an ACGME-accredited neurology residency.
• Satisfactory completion of an ACGME-accredited Vascular Neurology fellowship with at least 3 months in the neurointensive care unit or satisfactory completion of an ACGME, CAST, or UCNS-approved Neurocritical Care fellowship.
• Satisfactory participation in all ABNS CC/MOC requirements.

Radiologists

• Satisfactory completion of an ACGME-accredited residency in radiology and completion of a Neuroradiology fellowship.
• Satisfactory completion of at least 6 months of clinical service in a neurological surgery, vascular neurology, or neurocritical care program prior to entering the final advanced year of ES fellowship.
• Satisfactory participation in all ABR CC/MOC requirements.

Preliminary Endovascular Training

• Performance of at least 200 catheter-based diagnostic and/or interventional cerebral angiographic procedures as primary operator completed during residency, preliminary subspecialty fellowship, or as a separate experience after completion of residency or during the CNS endovascular fellowship.
• Demonstrated competency in catheter techniques, as validated by the CNS-ES Fellowship Program Director.
• Expected knowledge of cerebrovascular diseases completed and approved by both the residency and fellowship program directors.

Preliminary Training Curriculum

• Proper use of needles, catheters, guidewires, and contrast material.
• Fundamental understanding of radiation physics, biology, and safety.
• Interpretation of cerebral angiography, neurovascular, and neuroradiological studies.
• Pathophysiology of cerebrovascular diseases.
• Coagulation pathways, testing, and manipulation.
• Evaluation and management of patients with cerebrovascular diseases.
• Critical care management of the acute vascular patient, including placement of invasive monitoring devices.
• Clinical indications, risks, and limitations of endovascular neurosurgical procedures.
• Understanding alternatives to NES including medical and surgical options.
• Generating procedural reports that include and adhere to CPT coding.

Advanced CNS Endovascular Training Year Requirements

• A minimum of 12 to 24 months (of which the final 12 months need to be continuous) of a dedicated CNS-ES fellowship experience during which the fellow performs a broad spectrum of endovascular procedures as defined by core-competency requirements.
• Requisite knowledge and competency in the diagnosis and treatment of cerebrovascular diseases including extracranial and intracranial occlusive atherosclerotic disease and dissection in CNS-ES approved by the CNS-ES Fellowship Director.

Advanced Training Curriculum

• Arterial and venous angiographic anatomy of the brain, spinal cord, head, neck, and spine including:
  • Collateral anastomoses, anatomic variants, and modifications induced by disease processes.
  • Bony and soft tissue anatomy and physiology of brain, head, and neck, and spine.
  • Cerebral blood flow and its physiology and pharmacology.

Sponsoring Institution

The Sponsoring Institution is the University of Cincinnati College of Medicine in the city of Cincinnati, OH, and shall serve as the PRIMARY CLINICAL SITE. The UC Office of Graduate Medical Education, and the Departments of Neurological Surgery, Neurology, and Radiology have supported and continue to support this fellowship.

Participating Sites

At present, with the anticipated complement of ONE fellow per year to be accepted to this program, the fellow is dedicated to the primary site alone for all clinical, educational, and research activities.

Equipment and Facilities

The University of Cincinnati Medical Center continues to improve its state-of-the-art imaging facilities and endovascular facilities. UCMC has 3 high-speed 1.5 and 3 Tesla MRI for inpatient and outpatient use with DWI and PWI capabilities. Two emergency CT scanners (256-slice) with CT perfusion and CT angiography and two additional in-patient CT scanners (256-slice) with CTA and CTP capabilities are available 24/7.

Clinical Resources

The combined Endovascular surgery program and the stroke program at UC provide a plethora of diverse and complex illnesses. The endovascular service receives, on average, 3 in-patient consults daily while also evaluating 2-3 patients daily for out-patient procedures.

Learning and Teaching Environment

Fellows in this program are part of a team of educators. It is expected (and evaluated) that fellows provide education to nurses, technologists, students, and residents from the neurosciences and radiology. They are also expected to integrate education through presenting and participating in quality assurance and performance improvement programs.

Personnel

With four primary teaching/core faculty dedicated to performing procedures exclusively at UCMC, the fellow has unfettered access to didactic and research opportunities. Daily rounds of the endovascular service with image-based reviews, weekly imaging-based endovascular conferences, and journal clubs are mandatory for faculty as much as they are mandatory for fellows. Fellows will undergo closely supervised training (direct supervision) over the course of the 12 months by all core faculty members with immediate, post-procedure team-based feedback (the “Debrief”).