Supervisor: Dr. Tom Marotta
St. Michael’s Hospital, located in the heart of Downtown Toronto, is a major teaching and research hospital with expertise in diverse areas of health care. It is affiliated with the University of Toronto, one of the world’s premiere universities, and its Faculty of Medicine ranks among the world’s elite medical schools.
Our Neurovascular Program is a busy multidisciplinary service with staff from Interventional Neuroradiology (INR), Neurosurgery, Neurology, and Neurocritical Care. The INR fellows are provided an opportunity to run the service with full clinical management responsibilities. This is done with careful supervision from our four main staff neurointerventionalists: Dr. Thomas Marotta, Dr. Aditya Bharatha, Dr. Dipanka Sarma (Neuroradiology) and Dr. Julian Spears (Neurosurgery). The purpose of our Fellowship Program is to comprehensively train future neurointerventionists for a career in clinical care, research, and teaching.
We are a high volume referral center for the endovascular management of complex neurovascular conditions. We perform large volumes of endovascular aneurysm repairs and carotid artery stenting procedures annually. We are a designated Comprehensive Stroke Center and a designated Trauma hospital. We routinely treat acute large vessel ischemic stroke, dural arteriovenous fistulae, brain and spine arteriovenous malformations, epistaxis and perform pre-operative embolizations and vertebroplasties.
We have a busy weekly Neurovascular Clinic where fellows see the majority of the new patients and follow-ups under the guidance of the staff physicians. Apart from this, we also have an Acute Carotid Clinic, mainly run by the fellows, that sees patients with carotid artery stenosis and other pathologies referred to us through our dedicated website carotid.ca. These patients are seen urgently and booked for endovascular stenting if deemed necessary.
We have three main monthly conferences. Interesting and difficult aneurysm, arteriovenous malformation and dural fistula cases are planned for in the Neurovascular rounds with all four INR staff in attendance. Stroke rounds occur every last Monday of the month and are held together with the Neurology service. During these rounds, the latest trends in the management of stroke patients are presented and critically appraised by the INR fellows together with the Stroke fellow. Lastly, we also participate in the St. Michael’s Hospital Brain and Heart Innovation rounds, where latest technology for the treatment and diagnosis of neurovascular and cardiovascular conditions are discussed.
The INR service has excellent access to anesthesia. Our clinical service is also supported by a very capable and dedicated Advanced Practice Nurse and highly efficient clerical staff. Currently, we utilize a dedicated Siemens biplane flat panel neuroradiology suite. Renovations are already under way for two brand new bi-plane Philips rooms. Non-invasive neurovascular imaging is efficiently obtained in our three CT scanners and four MRI machines (two 1.5 T and two 3 T).
Current research interests of the group include intracranial flow diverters, imaging and management of cerebral vasospasm, carotid artery stenting for asymptomatic patients (CREST 2) and technical maneuvers in acute stroke intervention. Dr. Marotta has additional unique experience and opportunities for innovative device evaluations and development. We also have a research support staff that maintains aneurysm and carotid stenting databases available for the fellow’s research projects. To help disseminate the fellows’ research, we also have dedicated hospital funding to support presentations in international conferences. Furthermore, participation in ongoing clinical trials and animal research may be arranged. The most recent publications of the group can be found here.
To maximize clinical and procedural exposure, the program takes in only two fellows per year. Depending on the background training of the applicant the INR Fellowship may be a one- or two-year program. We accept applications from diagnostic neuroradiologists (who have completed at least one year of Diagnostic Neuroradiology Fellowship training), neurologists (who have completed at least one year of Stroke or Neurocritical Care Fellowship), and neurosurgeons. For fellows who have neurosurgical training there is an opportunity to participate in open neurovascular cases in the operating room. Participation in the Diagnostic Neuroradiology and Stroke services can also be arranged depending on the fellow’s goals. The two-year program can be performed at SMH or combined with another site.
The program strives to cultivate a collegial and educational environment that fosters close relationships between faculty and fellows; and encourages meaningful interactions with other clinical departments. We are looking for candidates who are willing to dedicate time and effort into being vital parts of our Neurovascular Team. We want them to learn from us everyday as we learn from our fellows as well. More than technical skills and research, we also strive for our fellows to be excellent clinicians, caring for patients in a multi-disciplinary environment. Their work is also balanced with healthy social and personal activities outside the hospital.
Neuroscience program link:
St. Michael’s Hospital Neurovascular program link: