Expanding the Thrombectomy Workforce: A Comparative Review of Outcomes Across Interventional Specialties

Background: Mechanical thrombectomy is a life-saving intervention for acute ischemic stroke (AIS) and is increasingly performed by a range of specialists—including interventional radiologists (IR), neurointerventionalists (INR), neurosurgeons (NS), and interventional cardiologists (IC). As demand rises and access disparities persist, expanding the thrombectomy workforce to include providers from diverse specialties may improve stroke care equity. However, questions remain regarding whether operator specialty affects patient outcomes. This review was conducted to evaluate the interprofessional performance landscape and inform future collaborative training and credentialing models.
Methods: A systematic literature review was conducted using Semantic Scholar database to identify studies comparing thrombectomy outcomes by operator specialty. Inclusion criteria: adult AIS patients, thrombectomy with modern devices (stent retrievers or aspiration), operator specialty explicitly reported, and minimum 10 patients per group. Five observational studies (multi- and single-center) met inclusion criteria.
Results: Across studies, no consistent differences were observed in key outcomes such as 90-day modified Rankin Score (mRS 0–2), revascularization success (mTICI ≥2b), mortality, or symptomatic intracranial hemorrhage. While one study noted slightly better mRS outcomes with INR operators, broader trends suggest comparable efficacy and safety across IR, INR, NS, and IC. In one system, expanding provider eligibility increased thrombectomy rates from 6 to 15 per 100,000. However, most studies lacked robust data on credentialing, training pathways, or team-based coordination.
Discussion: These findings support a more inclusive, interprofessional approach to thrombectomy delivery. Rather than focusing narrowly on subspecialty background, training quality, institutional protocols, and interdisciplinary collaboration may be more critical to optimizing outcomes. This evidence aligns with the Quadruple Aim: expanding access (population health), maintaining outcomes (patient experience), minimizing bottlenecks (value), and reducing burden on overextended teams (provider well-being).
Conclusion: Our review highlights the potential for interprofessional, cross-specialty training models in endovascular stroke care. As stroke systems of care evolve, institutions and credentialing bodies should consider standardizing team-based competencies and embracing diverse interventional backgrounds to meet growing demand.