• Stroke

Endorsement of endovascular stroke therapy by multiple randomized controlled trials now makes it the evidence-based standard of care for acute large vessel occlusions.1 An expected outcome of this endorsement is the debate on who can or should treat acute ischemic stroke. Most of this activity is predicated on the assumption that there is going to be too much stroke to treat and not enough people to treat it, more on that later. Let us examine the ‘who’ and the ‘should’ part first. The multi-society consensus guidelines simultaneously published in several journals2 pretty much restrict stroke interventions to trained and practicing neurointerventionalists. This is bound to irk a few folks. Interventional cardiologists have successfully ventured beyond the heart, partly owing to a pioneering spirit of advancing the limits of minimally invasive therapies and partly because of a financial incentive.

There was an immediate reaction to the published stroke evidence in both the lay cardiology press and in respected journals. However, some of the articles touting the readiness of interventional cardiologists to offer endovascular stroke therapy bring to mind the Dunning–Kruger effect.3 ,4 Described by David Dunning and Justin Kruger in 1999, it is a cognitive bias that leads people to overestimate their abilities. This lack of insight and illusory superiority can affect judgment.5 ,6 Furthermore, skills in one area may induce a sense of invulnerability in another, and the effect may persist despite appropriate feedback.7

Obviously, interventional cardiologists are skilled physicians and that is not where this effect is applied. The Dunning–Kruger effect comes into play because of an assumption that a knack of manipulating wires …