Role of Vascular Specialists to Perform Intra-Arterial Delivery of Thrombolytics for Acute Thromboembolic Stroke

Acute management of thromboembolic stroke has undergone a paradigm shift in the last decade with the advent of intra-arterial delivery of thrombolytics. However, this area remains the domain of neuroradiologists. A handful of neurosurgeons and a very small number of cardiologists are performing such advanced neuro-rescue therapies. The window of time to treat patients with acute thromboembolic stroke can be extended if such therapies are more widely available. Vascular specialists in the next decade should focus on increasing training sites for neurovascular interventions. Such advances in neuro intervention by a wider circle of skilled physicians can reduce the morbidity and mortality associated with stroke. The nuances of such radical measures are interventionists attempting to perform stroke therapy. The nuances of such radical measures are interventionists attempting to perform neuro-coiling for aneurysm or arterio-venous malformation.

Our humble opinion is that vascular specialists should focus on learning cerebral arterial anatomy, the natural history and pathophysiology of stroke, imagining modalities to diagnose stroke, pharmacotherapy, hemodynamic management, building a multidisciplinary stroke service and providing dedicated training in the delivery of thrombolytics at the site of cerebral occlusion. Furthermore, proficiency in recognizing and management of complications is essential.

Aravinda Nanjundappa, MD, Sangeeta Mandapaka, MD, Robert Dieter, MD

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ROBERT S. DIETER, MD, RVT
Dr. Dieter is an interventional cardiologist and vascular medicine specialist. He has completed advanced fellowship in Vascular Medicine and Peripheral Vascular Interventions at Georgetown University/Washington Hospital Center in Washington, D.C.

With a patient care emphasis in Vascular Medicine, he specializes in the management of patients with complex vascular diseases. He manages patients with stroke, TIA, and those at risk for stroke, particularly those with carotid artery blockages requiring angioplasty/stenting or those with PFO. He also specializes in renal artery stenosis. In fact, Dr. Dieter has published on new and potentially safer methods to treat blockages in the renal arteries. Dr. Dieter performs minimally invasive abdominal aortic aneurysm repair (endograft). Dr. Dieter has extensive training in the management of patients with claudication, as well as those with critical limb ischemia and non-healing ulcers — particularly in patients with diabetes. Furthermore, Dr. Dieter is board-certified in interventional cardiology and specializes in angioplasty, stenting and myocardial infarction treatment. Although Dr. Dieter is a vascular medicine specialist and interventional cardiologist, his underlying philosophy is the prevention of disease. He completed an advanced fellowship with renowned experts in Preventive Cardiology. Dr. Dieter actively treats patients with complex dyslipidemias.

Dr. Dieter graduated Alpha Omega Alpha from medical school. He has written over 100 journal articles, eight book chapters, is on the editorial board of several medical journals, and lectures internationally on cardiovascular diseases. He is the editor of two textbooks on vascular disease.

ARAVINDA NANJUNDAPPA, MD, RVT
Dr. Nanjundappa completed medical graduation in Adichunchanagiri Institute of Medical Sciences, India. He is specialist in Internal Medicine and Cardiology. He has certification in Cardiovascular Disease, Internal Medicine and Interventional Cardiology. He has been resident and fellow at Seton Hall University, Shands Hospital, Washington Hospital Center. He has also served as Director of Vascular Medicine and Peripheral Interventions at Pitt County Memorial Hospital, Greenville, North Carolina. At present, he is working as an Associate Professor of Medicine and General Surgery at West Virginia University School of Medicine, Charleston, West Virginia. He is a Board-Certified Cardiologist and Interventionalist.

Recipient of numerous teaching, research awards and grants, Dr. Nanjundappa is author of more than 60 peer-review journal articles and text book chapters. A frequent national and international guest lecturer, he serves on the editorial boards of eight journals including: Angiology; Interventional Cardiology (Associate Editor); and The Internet Journal of Endovascular Medicine (Chief Medical Editor). Dr. Nanjundappa has participated in several important Clinical Trials including: CLEVER, CORAL, CAPTURE, CREST, HERCULES, MOBILITY, and CHOICES.