State of Accredited Endovascular Neurosurgery Training in India in 2021: Challenges to Capacity Building in Subspecialty Neurosurgical Care

The incidence of stroke has seen over a 100% rise in low- and middle-income countries (LMICs), from 1970-1979 to 2000-2008, while it has stayed nearly the same or decreased in several high-income countries (HICs). However, it has been primarily in HICs that endovascular neurosurgery has evolved to become the standard of care in the management of stroke along with becoming a key modality for managing aneurysms, vascular malformations, carotid artery disease, amongst others. With 30 million individuals suffering from the aforementioned conditions and 7.3% of overall deaths due to stroke alone, India has a particularly high disease burden that can be tackled by neurointerventional therapies. Despite stroke being a leading cause of death and a public health priority in LMICs like India, provision of endovascular neurosurgical care is extremely scarce, both in its infrastructure and the number of trained subspecialist practitioners. This opinion piece utilizes the case scenario of India to highlight how the disparity of endovascular neurosurgical care exists in the face of excellent training and delivery of general neurosurgery and its other subspecialties and highlights key recommendations. One major reason, which this article focuses upon, is the near complete lack of accredited subspecialty training in endovascular care for neurosurgeons in India in 2021. Given that the majority of neurosurgery fellowships in India are currently non-accredited in nature, professional neurosurgical societies in LMICs will play a key role in supporting fellowship accrediting bodies. With the absolute dearth of dedicated neuroendovascular training during neurosurgery residency in developing countries, coupled with the unique and specific needs of this subspeciality, it will be the establishment of high-quality, accredited fellowships that would be crucial for having the framework for delivering endovascular care.