Neurointerventional Surgery Fellowship

About the Program 

Director: Esteban Cheng-Ching, MD 

Our training program takes place at Miami Valley Hospital main campus, which is a 973 bed hospital, with level 1 trauma center and Comprehensive Stroke Certification by the Joint commission. Miami Valley Hospital is the main teaching hospital for Wright State University Boonshoft School of Medicine, and multiple ACGME approved medical residency programs (including Neurology) and fellowship programs (including vascular neurology). Miami Valley Hospital has been a Joint Commission certified Comprehensive Stroke Center since 2015, and it is the main Hub for stroke care for the Premier Health Stroke Network serving multiple (9) spoke hospitals and free-standing emergency rooms.

The CNSI Telestroke team provides rapid tele-stroke care to patients presenting at four other hospitals within our system (Miami Valley South Campus, Miami Valley North Campus, Atrium Medical Center, Upper Valley Medical Center), two free standing Emergency Departments, and three hospitals outside the Premier Health System. Through this Telemedicine service, patients presenting with an acute ischemic stroke are evaluated for acute care, reperfusion therapies, and when required are transferred to Miami Valley Hospital (Hub) for thrombectomies and higher level of care.   

Patients with various neurovascular disorders (such as intracerebral hemorrhages, subarachnoid hemorrhages, subdural and epidural hemorrhages, intracranial aneurysms, arteriovenous malformations, arteriovenous fistulas) requiring neurosurgical or neurointerventional care are transferred to Miami Valley Hospital and admitted to the neurocritical care unit and/or stroke/neuroscience units. The neurocritical care unit is a 36-bed state of the art unit, with a 2-1 nursing ratio and staffed by an attending with vascular and neurocritical care training, residents, fellows and advance practice nurses.

The CNSI stroke service is supervised by our experienced Stroke attendings who care for all stroke patients within Miami Valley Hospital. The team is made up of Stroke attending, stroke fellow, Sr and Jr neurology residents, Resident rotators, medical students, and stroke trained APNs. The team provides care in the neurocritical care unit and neurology unit.   

The Miami Valley Hospital Emergency Room is one of the largest in Ohio, with 76 beds and 136000 visits last year. Premier Health also owns CareFlight (emergent air/ground transfer service) for around the clock emergent transportation service with 4 Dauphin helicopters and 6 ground mobile intensive care units based across various hospitals in our region with a dedicated Stroke Alert protocol that allows rapid transportation of stroke patients to Miami Valley Hospital for advanced reperfusion therapies.  

The CNSI also includes several busy surgical subspeciality groups. The CNSI Neurosurgical team cares for common and complex neurosurgical conditions. MVH has a Level 1 Trauma designation with an experienced Trauma team, and a growing ENT team now offers the latest in ENT surgeries and provides the complement for our team, allowing for comprehensive care of neurovascular patients, as well as variety of case exposure to the fellows in training.

All of these characteristics of our health system and multidisciplinary care, allow us to treat a large number of highly complex patients with neurovascular disorders.  This population of patients is ideal for fellowship training, ensuring a good representation of all neurovascular disorders, including common conditions and rare and complex conditions. 

Our training program is a two-year program which provides in-depth and comprehensive training guaranteeing an excellent experience in the neurointerventional management of patients with cerebrovascular disease. The fellowship program provides the trainee with the knowledge, tools, and skills to be a successful and safe endovascular surgeon. In addition, we provide the academic, clinical, and practical training to care for patients with cerebrovascular disorders.  

Neurointerventional Surgery Team

The NeuroInterventional Surgery service is an integral part of the care of patients with neurovascular conditions. This team consists of three, ABPN and CAST board certified, neurointerventional neurologists, one NIS Fellow, two dedicated and NIS trained APNs, and a NIS outpatient clinic team (RNs, and MAs).  Miami Valley Hospital has two dedicated biplane angio-suites available with state-of-the-art technology and staffing. 

Our Interventional Neurology practice requires collegial interactions with other specialties, including; but not limited to, Neurosurgery, Neurocritical care, Neurology, Radiology, Anesthesiology, Emergency Medicine, ENT, Trauma surgery, Oncology and Cardiology. 

During the training process, the fellow will be expected to round daily on patients with cerebrovascular disorders, for which our service was consulted, and make decisions related to management options and plans. With the NIS staff, the fellow will create and implement procedural plans and schedules. The fellow will then participate actively in the procedures scheduled each day, as well as in any emergency procedures which arise. During the procedures, the fellow will initially work alongside the NeuroInterventional Surgery attending. Over the two-year training process, the fellow will gain gradual autonomy. The expectation is for a successful fellow to gain hands-on experience with the goal being to perform all neurointerventional procedures safely on their own. By graduation of fellowship training, we would anticipate the fellow to have participated in more than 500 cases and be more than capable of independent practice with the highest quality care.

Lastly, the fellow will also master post-operative care of these patients alongside the interventional neurology attending and other specialties involved. The majority of fellowship time will be dedicated to procedural training; however, the fellow will have significant exposure in the NeuroICU, and outpatient NeuroInterventional Clinics as well.

Faculty

Director: Esteban Cheng-Ching, MD 

Core Faculty: Bryan Ludwig, MD, and John Terry, MD. 

Training Requirements 

• Pre-requisite: Neurology Residency, Neurosurgery Residency, Radiology Residency.  
• Additional Pre-requisite:
  • For Neurologists: Vascular Neurology fellowship and/or Neurocritical care fellowship. 
  • For Radiologists: Neuroradiology fellowship and/or Interventional Radiology training.

Curriculum

Structured learning is established to provide an optimal learning experience.   

• Neurointerventional case conference: Cases of the week are reviewed in detail, with emphasis on the discussion of treatment techniques.
• Vascular neurology case conference: Weekly on Wednesdays at 7am. During this conference is multidisciplinary, with attendings from various specialties present, including neurology, vascular neurology, neurointerventional surgery, neurosurgery and neuroradiology. Complex vascular neurology cases are presented, the history and presentation as well as imaging is reviewed, and the cases are discussed in detail.   
• Neurology Grand Rounds: variety of Neurology topics covered, including vascular neurology and neurocritical care topics.   
• Carotid conference: Cases with carotid pathology are presented and discussed. Attended by specialists in Vascular Neurology, Neurointerventional surgery, Vascular surgery and Cardiology.   
• Neurovascular Journal club: monthly.  
• Dedicated lectures on Interventional Neurology topics.

Attendance to one national meeting (Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology, International Stroke Conference) is expected at least once during the two-year period.  

Scholarly Activities

Participation in research projects is highly encouraged and expected.