University Health Network and Mount Sinai Hospital
Supervisor: Dr. Karel terBrugge
St. Michael's Hospital
Supervisor: Dr. Tom Marotta
A comprehensive training program in Interventional Neuroradiology (INR) is conducted at two University of Toronto affiliated Institutions: the Toronto Western Hospital and St. Michael's Hospital in Toronto.
The programs at the two Institutions are similar and will allow the applicants to become proficient in the management of patients with vascular disorders of the central nervous system. Treatment procedures at both Institutions include management of patients with brain and spinal AVMs, dural AVFs, vascular malformations of the head and neck region, including epistaxis, as well as acute stroke and intracranial aneurysms. Stroke prevention techniques (angioplasty and stenting) as well as percutaneous spinal biopsy, vertebroplasty, kyphoplasty, nerve and facet blocks are being performed.
The program at TWH includes exposure to pediatric interventional procedures at the Hospital for Sick Children in Toronto. The multidisciplinary team at the TWH includes stroke neurologists and vascular neurosurgeons as well as stereotactic neurosurgeons. Weekly multidisciplinary AVM and Aneurysms Clinic are held, as well as weekly stroke rounds and neurovascular rounds. About 300 diagnostic cerebral and 30 spinal angiographic and 250 interventional procedures are carried out per year at the TWH and another 50 interventional procedures are carried out yearly at HSC. About 100 percutaneous spinal procedures are performed each year.
The TWH has 2 state-of-the-art biplane neuroangiographic suites, one of which is physically connected to a 3T MRI facility allowing for easy transfer between MRI and DSA, which may be required during the management of patients with certain neurovascular disorders. One of the biplane angio suites is also OR compatible allowing for combined surgical and endovascular procedures to be performed.
The five staff INR neuroradiologists, Drs. terBrugge, Willinsky, Farb, Lee and Agid have fostered a program, which is internationally acclaimed for its academic commitment and scientific output ever since its inception in 1984 under the supervision of Dr. P. Lasjaunias of Paris, France.
The INR fellow at SMH is provided the opportunity to "run" the service with full management responsibilities. This is done with careful supervision from experienced staff in diagnostic neuroradiology, interventional neuroradiology, neurology, and neurosurgery. Our interventional staff currently includes three experienced individuals with neuroradiology background (Montanera, Marotta and Gray) and also one with neurosurgical background (Spears).
SMH has a dedicated neuroradiology suite with biplane and 3D. Imaging is done on 3 up-to-date multi-slice CT scanners with perfusion capabilities for stroke assessment. There are three 1.5 T MRI machines. CTA and MRA examinations are done routinely and efficiently.
Interventional clinical material is varied with high volumes of complex aneurysms and carotid and intracranial atherosclerosis as well as vascular malformations, pre-operative devascularizations, trauma, and stroke. SMH is a designated Stroke Center with triage protocols that include IA lysis and other clot specific maneuvers. Spinal interventions are also performed for vascular malformations, metatastic devascularizations, and vertebroplasties. Biopsies are done under fluoroscopy or CT guidance.
Teaching, clinical research, trial participation, and animal research opportunities are readily available. INR at SMH is participating in CREST with Dr. Montanera as our site PI. Dr. Spears has initiated a large and giant aneurysm worldwide registry. Dr. Marotta has experience and opportunities for innovative device evaluations and development. A full service animal lab with excellent digital imaging and support is present within the hospital.
The Interventional service is fully supported within the hospital environment and has excellent access to Anesthesia. There is a weekly Neurovascular clinic for new patient visits and follow up and a monthly Neurovascular conference for multidisciplinary discussion of complex cases. Weekly rounds are also held and entitled "Neuroscience" (rotating schedule of topics), "Neuroradiology" (for radiology residents plus others), and "Neurosurgery" (broad topic areas include Neurovascular, Skull Base and Oncology, and Spine).
Our clinical service is coordinated by a dedicated Clinical Nurse Specialist. The nurse provides excellent liaison with patients and their families and also amongst the various services involved within the hospital. Education for patients, families, and hospital staff is also part of the role.
Depending on the background training of the applicant the INR fellowship may be a one- or two-year program. Those applicants who already have completed a two-year fellowship in diagnostic Neuroradiology may apply for the one-year (senior) fellowship position in Interventional Neuroradiology. Those applicants who have not completed a two-year fellowship in diagnostic Neuroradiology will be eligible for the two-year program.
Applying for a Fellowship