In defense of our patients

We read with interest and dismay the article ‘Public health urgency created by the success of mechanical thrombectomy studies in stroke’ recently published in Circulation. 1 There is now overwhelming, class 1, level A evidence supporting mechanical thrombectomy (MT) as the standard of care for eligible patients with acute stroke secondary to an emergent large vessel occlusion (ELVO). We agree that attention must be focused on how to translate this evidence into better outcomes for more patients. However, the opinions expressed by Drs Hopkins and Holmes lead to unwarranted conclusions that have dangerous implications for patient care. Their article reflects (1) a disregard for training, expertise, and experience in the management of a disease that may lead to death or disability when treating physicians do not have them; (2) a misunderstanding of the fundamental underpinnings of stroke physiology and anatomy; and (3) a false association between a real problem (undeveloped systems of care) and a spurious assumption (ie, that there are not enough physicians trained to perform intracranial MT). We examine these concerns below. The primary issue is one of training. The field of neurointervention is shared by physicians with different specialty backgrounds who have completed rigorous fellowship training in neurointerventional surgery. Neurointerventionalists are uniquely open to the inclusion of …