Introduction

Endovascular neurointervention is an exciting and rapidly growing field that is revolutionizing the treatments and approaches for both hemorrhagic and ischemic cerebrovascular disease. Originally the domain of neuroradiologists who pioneered and perfected methods of diagnostic cerebral angiography, the burgeoning discipline of neurointervention grew to encompass ever more therapeutic procedures. Subsequently, neurosurgeons have sought out training in neurointerventional techniques, enriching their therapeutic armamentarium, supplementing their surgical expertise in the management of aneurysms, dural arteriovenous fistulae and arteriovenous malformations. More recently, just as neurosurgeons were lured into hybrid training in both open and endovascular technique to treat hemorrhagic disease, stroke neurologists are filling fellowship positions with a particular interest in the interventional management of ischemic diseases of the cerebrovasculature, ranging from acute ischemic stroke to intracranial and extracranial stenoses and occlusions.

In Europe, for political and historical reasons, a traditional model is followed in which the lion's share of the neurointerventional work has remained in the realm of neuroradiologists. However, in the USA, the convergence of the three subspecialties (neurosurgery, stroke neurology and neuroradiology) in this field creates the unique opportunity for a truly multidisciplinary effort with obvious implications for improved patient care, exemplified in the revised name of the Society of Neurointerventional Surgery (SNIS), reflecting the present reality of endovascular neurointerventional surgery as practiced by clinicians hailing from three neuroscience backgrounds.

A multidisciplinary environment that is collegial can greatly benefit fellowship training and both junior and senior practicing attendings. At the Cleveland Clinic, an accredited council for graduate medical education (ACGME)- approved fellowship in endovascular neurosurgery has been in place since 1 July 2003, with two positions offered yearly. Mirroring the rubric of the multidisciplinary Cerebrovascular Center, in which physicians from diverse specialties share administrative and financial interests (disease centric model, …