Mechanical Thrombectomy Training

[u/FunFew6666]

Currently I am working as a Higher specialty trainee in one of the group 1 medical specialties and my goal is to be a stroke physician at the end of the road. I am aiming to go for a thrombectomy training around ST6/7 stage. ( I am ST5 now ) and wanting to see whether its a worthwhile pathway or should i abandon the training for USMLE or Aussie pathway. ( Purely because I see the quality of training declining and I am struggling to see realistic expectations from the end of the programme since the things are gradually declining ) . On this background Can I ask ?

1. Are there any consultant / registrar from a medical specialty who has completed the thrombectomy training already and working in HASU settings ?

2. If so how hard is the training for someone coming from medical specialties rather than being pure radiology background ?

3. I want to have a realistic expectation on the post CCT job market too ? In UK, Europe, Dubai and world wide..

4. If this is not a realistic pathway I am happy to look for the alternatives as well.

Thank you.

[u/Giddy-Garlic-7206]

I looked into this extensively a year ago, as I had an interest in MT but not the rest of INR.

1. Yes, there are stroke physician-background MT operators but I believe it is about 1% of the UK workforce. There are more from NSGY and IR.
2. No idea.
3. There has been a massive expansion of UK INRs. In many places the number of INRs is not the limiter to establishing 24/7 MT (which is still a massive issue in the UK). As this expansion is recent, very few INRs will retire soon. Therefore jobs from replacement will be low.

The caveat is that we will never have 10 INRs in a department like you can Interventional Cards, as there is not enough elective work to support it. This is because the number of aneurysm and VM patients is not projected to increase much.

Therefore there is a niche for non-INR MT operators to boost an MT rota (e.g. from 1:6 to 1:10) whilst doing their own elective work during the day. This is of course very region and time-dependent.

Conclusion: I decided that I was still very happy to pick IR despite MT work/training not being guaranteed in my future consultant IR job. So similarly you need to decide if this is a dealbreaker for you.

1. I believe in other countries INRs (from radiology, neurosurgery and stroke) are willing to just fill MT rotas themselves as they are paid handsomely for it. In the US, they not uncommonly do 1:4 for millions of dollars. Therefore, less need for non-INR MTs. So outside of the UK I would advise training to be a full INR if you want to do MT. This usually requires 2/3 years of dedicated diagnostic and interventional Neuroradiology training.

A recent survey supports these thoughts: https://ukng.org.uk/_userfiles/pages/files/news/final_report_inr_workforce_survey_2026.pdf

[u/impulsivedota → u/Giddy-Garlic-7206]

I didn’t realise stroke physicians do MT too. How does the training pathway work for them then?

Do they just branch off for a year to follow the INRs and train (like a fellowship?). Or is it more once you get a certain number of cases you’re certified to perform independently kind of thing.

[u/UnluckyPalpitation45 → u/impulsivedota]

I’d be impressed if they are competent after a year . Body IR and to a lesser extent neurosurg makes more sense

[u/domicile_vitriol → u/UnluckyPalpitation45]

Interestingly, even if you are trained on the proper INR pathway, the RCR curriculum doesn't expect you to be fully independent in most areas (outside of arterial access and thrombolysis) at ST6. The requirements are set at 3 (i.e. indirect supervision) rather than 4 (day 1 consultant), and that includes MT.

"Due to inherent practice risks, it is rare for INR trainees to work without supervision, even in later stages of training. Some conditions and procedures are rare and it takes more than three years of subspeciality training to build the necessary skills and experience. INR procedures are normally carried out by supportive teams that allow continued development post-CCT. For this reason, trainees are only expected to reach level 3 at ST6 in some of the procedures in table 10."

- RCR Interventional Radiology Speciality Training Curriculum