The increasing demand for neurointerventional specialists has led to a growing acceptance of neurologists into dedicated neurointerventional training programs. In this blog piece we present two perspectives of training pathways for neurologists in the delivery of endovascular thrombectomy: Romania and Turkey.

Dr Mihai Ionescu:

Training in neurointervention is carried out according to national authorities and follows country-specific training pathways. Consequently, training duration, procedural requirements and eligible trainee backgrounds vary considerably across Europe. To promote standardisation and high-quality training, the European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR) and the European Union of Medical Specialists (UEMS) have previously published¹ guidelines outlining recommended training requirements in interventional neuroradiology.

Since 2023, Romania has implemented a dedicated subspecialty neurointerventional training program that accepts trainees from diverse medical backgrounds including radiology, neurology, neurosurgery and pediatric neurology. We believe this model may be informative for healthcare systems currently facing shortages of neurointerventionalists and low endovascular treatment rates.

I would strongly recommend clinical fellowships such as the European Stroke Organisation Department-to-Department Visit Programme^2,3 or the ESMINT fellowships⁴  which currently provide valuable exposure for neurologists in high-volume European centers.

Dr Ionescu personal archive photographs from the 2020 ESO Department-to-Department Visit Programme at the Centre Hospitalier Universitaire Dupuytren, Interventional Neuroradiology Department, Limoges, France which subsequently led to Fellowship Training and completion of a University Diploma in Interventional Neuroradiology in Limoges.

Dr Atilla Odezmir:

Under the umbrella of the Turkish Cerebrovascular Diseases Society (Türkiye Beyin Damar Hastalıkları Derneği), a structured “Interventional Neurology” diploma (board certification) program for neurologists was initiated in 2012. As of 2026, the number of board-certified “Interventional Neurologists” trained through this one year program who actively perform mechanical thrombectomy and endovascular secondary prevention procedures for ischemic stroke is 65. Among them, 16 are women interventional neurologists. In response to the landmark randomised endovascular therapy trials published in 2015, a two-step training model was adopted, aiming to prepare interventional neurologists not only for mechanical thrombectomy but also for comprehensive stroke center organisation and the development of regional stroke systems of care.^2,3

Standardised accreditation and competency-based assessment are central to ensuring patient safety and consistent quality across centers.^2,3 The programmes have been award winning and supported by the Turkish government.

This has changed the face of stroke care in Turkey – as of 2026, 29 comprehensive stroke centers across the country are led by interventional neurologists, and mechanical thrombectomy is routinely performed in these centers.

Our accredited training centers under the Turkish Cerebrovascular Diseases Society are prepared to host and train visiting interventional neurologists from abroad.

In collaboration with the European Stroke Organisation, we are ready to welcome neurologists from across Europe to provide both structured mechanical thrombectomy training and capacity-building support for European countries with unmet needs for thrombectomy services.

1. Sasiadek M, Kocer N, Szikora I, et al. Standards for European training requirements in interventional neuroradiology guidelines by the Division of Neuroradiology/Section of Radiology European Union of Medical Specialists (UEMS), in cooperation with the Division of Interventional Radiology/UEMS, the European Society of Neuroradiology (ESNR), and the European Society of Minimally Invasive Neurological Therapy (ESMINT). J NeuroIntervent Surg. 2020;12(3):326. doi:10.1136/neurintsurg-2019-015537

2. Mehmet Akif Topçuoğlu, Atilla Ozcan Ozdemir. Acute stroke management in Turkey: Current situation and future projection. European Stroke Journal 2023;8: 16-20.

3. Atilla Ozcan Ozdemir, Semih Giray, Erdem Gürkaş. Training standards for neurointerventional procedures regarding endovascular treatment and secondary endovascular protection of acute ischemic stroke. Turkish Cerebrovascular Disease Journal. 2023;29 (3):106-114

Simulation is an increasingly valuable tool in stroke education. It provides a safe and structured environment to train practical skills, improve decision-making, strengthen teamwork, and rehearse time-critical scenarios in acute stroke care. For junior clinicians as well as more experienced professionals seeking a refresher, simulation helps translate knowledge into action.

At ESOC 2026 in Maastricht (6–8 May 2026), the ESO Simulation Education Committee will host four Hands-on Simulation Workshops on Thursday, 7 May 2026. We will simulate two acute stroke cases in a simulated emergency department environment with you actively role-playing the physician part. These small-group sessions are designed to provide practical, case-based learning with direct faculty feedback, and places are limited. Workshops can be booked separately during ESOC registration on a first-come, first-served basis.

Here is what to expect from each workshop:

Workshop A | 08:30–10:00 – Simulation Workshop on Code Stroke: From Diagnosis to Early Treatment

A practical workshop on acute stroke diagnosis, early treatment, door-to-treatment times, and crew resource management in the hyperacute setting. Particularly suited to participants looking for a structured overview of the code stroke pathway, either as a starting point for simulation-based training or as a focused refresher of core principles.

Workshop B | 13:15–14:45 – Simulation Workshop on the Management of the Deteriorating Patient After Reperfusion Therapy

Focused on the acutely deteriorating patient after reperfusion therapy, with emphasis on decision-making, communication, shared mental models, and interprofessional learning. Especially relevant for participants interested in teamwork and crisis management in a high-pressure scenario.

Workshop C | 15:00–16:30 – Simulation Workshop on the Management of Complex Acute Stroke Cases

Dedicated to challenging stroke presentations, including complications, frailty, and contraindications to treatment. Particularly suitable for participants with prior experience in acute stroke care who want to deepen their approach to complex cases and nuanced treatment decisions.

Workshop D | 17:00–18:30 – Simulation Workshop on Tele-Stroke Management in the Acute Stroke Setting (Joint Session of the ESO Stroke Simulation Committee and the ESO Telestroke Committee)

This workshop explores simulation training in a telestroke environment, including remote assessment, communication, NIHSS scoring, workflow optimisation, and complication management using telemedicine equipment in a controlled simulated setting. Especially relevant for participants interested in understanding the operational principles of tele-stroke services and gaining initial experience within such an environment.

As each workshop takes place in a different time slot, participants are welcome to register for more than one session and build a progressive learning experience across the day.

Whether you are early in your stroke career or looking to refresh essential practical skills, these workshops offer a unique opportunity to learn by doing.

Places are limited! Book your workshop during ESOC registration and join us in Maastricht, Thursday 7 May 2026: #VoiceOfStroke.

The 27th webinar of the European Stroke Organization’s educational series was hosted by Dr. Marieta Peycheva and Dr. Ellis van Etten. With the title “Intravenous thrombolysis in patients with relative and absolute contraindications: how far should we go?”, it features Dr. Thomas Meinel (Inselspital, Bern University Hospital, Switzerland) and Dr. Odysseas Kargiotis (University of Patras, Greece) discussing the boundaries of intravenous thrombolysis (IVT) in some complex situations.

The first part of the discussion regarded patients on direct oral anticoagulants (DOACs), highlighting a case where a patient with high rivaroxaban levels was treated with IVT without complications. Although 2021 ESO guidelines are restrictive regarding DOACs, recent observational data and the 2026 American guidelines suggest that high plasma levels might not always preclude treatment with an individualized risk-benefit analysis. While idarucizumab is a common and safe reversal agent for dabigatran, the use of andexanet alfa as reversal of rivaroxaban/apixaban is not recommended before IVT primarily due to a documented increase in thrombotic events. Ongoing RCTs will clarify the safety and efficacy of IVT in this scenario and results are expected 2028.

The dilemma of minor strokes is another key topic, exemplified by a case where IVT treatment for a mild disabling deficit (left hemiparesis with impaired gait, NIHSS 4) resulted in a fatal brainstem hematoma. Although underpowered and yielding non-statistically significant results, the PRISMS trial demonstrated a trend that alteplase may not benefit minor non-disabling strokes, suggesting that IVT should be avoided in these particular cases. The definition of “disabling” remains inherently subjective and requires careful clinical judgment. However, in patients with large vessel occlusions (LVO) and mild symptoms, some evidence suggests IVT may still be beneficial.

Regarding post-operative patients, guidelines generally suggest waiting 14 days after major surgery, yet the experts emphasize that individual circumstances, such as a non-traumatic spinal puncture, might allow for earlier intervention and communication with the surgeon might be helpful for decision-making.

Patients with a history of stroke were also addressed. Non-randomized data and meta-analyses indicate that previous ischemic strokes generally do not significantly increase haemorrhage risk, though clinical outcomes are often poorer due to pre-existing disabilities. However, strokes occurring within the prior two weeks signal a higher risk for symptomatic haemorrhage, requiring careful consideration of timing and lesion size. In patients with a history of haemorrhagic stroke, the underlying cause is the primary risk predictor. In this context, the two speakers challenge the strict use of microbleed counts: to contraindicate IVT, physicians should rather look for the presence of potential Cerebral Amyloid Angiopathy (CAA)-related symptoms than simply consider exceeding a threshold of ten microbleeds.

For patients with unknown stroke onset times, the consensus is that advanced imaging such as CT perfusion or MRI is mandatory to identify salvageable tissue, as treating without such data beyond standard windows is risky.

In other special scenarios, IVT is considered reasonably safe during pregnancy for disabling deficits but requires caution in cases of recent large myocardial infarctions or long-bone fractures due to systemic bleeding risks. Finally, the presenters stress the importance of individualized care and involving patients and families in decision-making for borderline cases, noting that legal requirements for informed consent vary significantly across different countries.

The 13th ESO ESMINT ESNR Stroke Winter School was held in Bern, Switzerland, from January 27 to 30, 2026. Under the leadership of PD Dr. Thomas Meinel, PD Dr. Tomas Dobrocky, Prof. Urs Fischer, Prof. Jan Gralla, PD Dr. Eike Piechowiak and PD Dr. Bastian Volbers, the local organizing team once again delivered an outstanding educational event dedicated to advances in acute stroke care. We also warmly acknowledge the invaluable administrative support provided by Kadra Abdullahi, Alice Caneva, Mara Megert and Selini Tsimachidis, whose coordination ensured the smooth running of the course.

The Winter School reaffirmed its central objective: strengthening interdisciplinary collaboration between neurologists and neuroradiologists throughout Europe. Interest in the program remained remarkably high, with about 200 applications submitted for 66 available places, highlighting its continued relevance and reputation. This year’s participants represented 20 countries: Albania, Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Germany, Italy, Lithuania, Montenegro, Netherlands, Northern Ireland, Norway, Poland, Portugal, Romania, Spain, Sweden, Switzerland, Ukraine and United Kingdom.

The course opened with welcoming remarks from PD Dr. Dobrocky and PD Dr. Meinel, followed by addresses from Prof. Simona Sacco (ESO) and Prof. Jan Gralla (ESMINT, ESNR). From the outset, the scientific sessions tackled key developments in stroke medicine, including global epidemiological trends, recent progress in thrombolysis and mechanical thrombectomy, and innovations in prehospital stroke pathways.
The 2026 edition featured a comprehensive academic program consisting of 30 lectures, four interactive tutorials and three practical workshops. In total, 34 faculty members from seven countries contributed to the teaching program, providing a broad international perspective. The faculty included experts from across Europe fostering lively discussion and exchange of experience across healthcare systems.
A core strength of the Winter School remains its strong practical focus. Participants worked in small groups, allowing close interaction with faculty during hands-on sessions covering neuroangiography techniques and complex endovascular interventions. Tutorials addressed crucial topics such as procedural strategies in endovascular stroke therapy, prevention and management of complications, workflow optimization and advanced imaging interpretation.

Neuroradiologists benefited from simulator-based training and live animal laboratory sessions, where thrombectomy procedures were practiced under direct expert supervision. Neurologists took part in structured stroke simulation workshops designed to replicate real-world clinical scenarios. These sessions emphasized rapid decision-making, interdisciplinary communication, team coordination and time management. The simulation component also served as an introduction to formal simulation certification and encouraged participants to establish regular simulation training at their home institutions.

In addition to the core topics of thrombolysis and mechanical thrombectomy, the 2026 scientific program addressed a broad spectrum of clinically relevant and challenging scenarios. Sessions focused on evolving indications for thrombectomy, stroke in patients with specific risk profiles such as anticoagulation, cervical artery pathologies, haemorrhagic stroke, and diagnostic challenges including stroke mimics and TIA. Interactive case discussions and morbidity/mortality sessions fostered critical reflection, interdisciplinary exchange and a constructive learning culture in acute stroke care.

The success of the 13th Stroke Winter School was made possible through the generous support of our sponsors: 1a Medical, Boehringer Ingelheim, Johnson&Johnson MedTech, Medtronic, OM Pharma, Penumbra, Siemens Healthineers, Stryker, Terumo Neuro, Vascular Medical and Wallaby Phenox. Their commitment allowed us to maintain a high-level educational offering while keeping participation accessible, particularly for early- and mid-career physicians and colleagues from developing European countries.

With another highly successful edition concluded, the organizing committee extends its sincere gratitude to all faculty members and participants for their enthusiasm and commitment to improving stroke care. We look forward to welcoming the stroke community back to Bern for the 14th ESO ESMINT ESNR Stroke Winter School, scheduled for February 2–5, 2027. In response to sustained international interest – including applications from South America, Asia and Africa – the Stroke Center Bern continues to expand its global educational initiatives. Preparations are underway for the next Asian Stroke Summer School and for the further development of the South American Stroke School, both in close collaboration with regional faculty to ensure content tailored to local clinical needs.

More about the Winter School

I would like to express my sincere gratitude to the European Stroke Organisation (ESO) for granting me the opportunity to participate in the Department to Department Visit Programme. This experience offered an exceptional chance to expand my clinical and research competencies in stroke medicine, gain insights into a leading European stroke centre, and establish valuable professional connections.

My decision to choose UKE Hamburg as my host institution was straightforward. UKE has an outstanding reputation in stroke care, research, and innovation, and has played a significant role in several landmark clinical trials, including the WAKE-UP study, which investigated MRI-guided thrombolysis in wake-up strokes. The organisation of the visit was smooth and efficient, and I am deeply grateful to Prof. Dr. Götz Thomalla, who was exceptionally supportive and welcoming, as well as to Tamara Wichmann (Assistant to the Clinic Director) for her kind and helpful coordination.

Stroke Unit

During my stay, I was integrated into the daily workflow of UKE’s modern and well-organised Stroke Unit, which includes 10 single-bed rooms, two three-bed rooms, and two two-bed rooms.

My activities included:

• Participation in the evaluation of patients presenting with ischemic stroke, TIA, and hemorrhagic stroke,
• Differential diagnosis of acute neurological deficits, including stroke mimics,
• Attendance and participation in morning rounds with senior neurologists and residents,
• Observation of workflow, multidisciplinary communication, and logistics of the unit, from admission to discharge,
• Exposure to the use of echocardiography (TTE/TEE) and long-term ECG monitoring in stroke diagnostics,
• Daily admission and case discussion meetings,
• Insight into patient flow, decision-making pathways, and rapid diagnostic processes within a highly coordinated stroke centre.

Other Departments
Functional Diagnostics Laboratory

I visited the Functional Diagnostics Laboratory, where I had the opportunity to deepen my understanding of EEG usage in both outpatient settings and critical care.

Emergency Department

I spent several sessions in the Emergency Department, observing the acute triage and management of neurological patients. My activities included:

• Assessment of differential diagnoses, such as metabolic disturbances, seizures, migraines, and functional disorders,
• Observation of the acute stroke workflow, from prehospital notification to imaging and treatment decisions,
• Participation in the evaluation of both neurological and non-neurological emergencies.

Neuroradiology Department

In the Neuroradiology Department, I observed several interventional procedures, including:

• Coiling of intracranial aneurysms,
• Stenting of carotid artery,
• Imaging evaluation and treatment planning for complex neurovascular pathologies.

These experiences highlighted the importance of close collaboration between neurologists and interventional neuroradiologists.

Neurovascular Board

I attended the Neurovascular Board meetings, where neurologists and interventional neuroradiologists reviewed and discussed complex cases, arteriovenous malformations, carotid stenosis, and other challenging diagnostic and therapeutic cases. These multidisciplinary discussions offered valuable insights into structured decision-making and evidence-based treatment planning.

Personal Experience and Impressions

Hamburg is a vibrant and beautiful city, and I found it a very enjoyable place to stay. The atmosphere at UKE was extremely welcoming. My mentor, Priv.-Doz. Dr. Bastian Cheng, as well as all team members, were friendly, open, and always willing to explain clinical reasoning or procedures in detail. I felt fully integrated into the team and appreciated the collegial environment throughout my stay. A huge thank you to them!

Conclusions

My visit to UKE Hamburg was enriching both professionally and personally. I gained valuable clinical experience in stroke diagnostics and acute management, advanced my understanding of neurovascular interventions, and deepened my knowledge of essential diagnostic modalities.

Witnessing the organisation and efficiency of stroke care in a high-volume, research-active centre was particularly inspiring. I am deeply grateful to the European Stroke Organisation for supporting this programme and to UKE Hamburg for hosting me so warmly. This experience will significantly contribute to my future clinical work, academic development, and dedication to the field of stroke medicine.

The experience I had in Oxford and the knowledge I acquired over the past six months were highly meaningful and allowed me to grow both professionally and personally. This was made possible in part thanks to the funding provided by the European Stroke Organisation through its Department to Department Visit Programme. I am therefore very grateful for this support, as this research placement has enabled me to enrich my current project, which involves the application of a novel therapy using functional electrical stimulation coupled to a P300-based brain–computer interface for upper limb motor rehabilitation in chronic stroke survivors.

Spending six months studying and conducting research in Oxford was the most unique and special experience. At first, it was difficult to realise not only the fact that I was at one of the oldest universities in the world—where some of the brightest minds in history once shared the same libraries, laboratories, and lecture halls in which I was now standing—but also that the historic and quaint nature of its buildings, streets, and colleges creates the illusion that time has stood still, making you feel in a fairy tale or Harry Potter story.

Additionally, I was able to get the most out of my time in Oxford under the mentorship of Prof. Charlotte Stagg and Prof. Melanie Fleming, who served as my host co-supervisors within the Physiological Neuroimaging and Plasticity groups at the Oxford Centre for Integrative Neuroimaging. From the moment I arrived, I felt very welcome in their laboratories, and I was particularly impressed by the pleasant and friendly working environment I found there, where everyone was willing to help, fostering a dynamic of collaboration and cooperation that I greatly enjoyed.

Moreover, I would like to highlight the amazing academic and scientific activities in which I participated during my research stay. I learned how to analyse neuroimaging studies obtained from subjects in the project we are conducting in Mexico, including magnetic resonance imaging and electroencephalography studies. In addition, I also had the opportunity to get involved and assist in a clinical trial at the John Radcliffe Hospital, where we applied beta transcranial electrical stimulation to improve upper extremity motor recovery in stroke individuals. Furthermore, through various workshops, I learned how to apply other non-invasive brain stimulation and neuromodulation techniques, and I attended conferences, seminars and symposia that allowed me to appreciate different approaches and methodologies to conduct research.

Finally, I was not only able to learn and benefit from my time in Oxford, but I was also able to contribute my own skills. This included doing physical examination assessments for the clinical trial in which I participated in, as well as training other students on how to perform and evaluate different clinical scales used to assess motor function and recovery in stroke patients, given I was previously trained at a tertiary rehabilitation center in Mexico, the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra. The above demonstrates that bidirectional collaboration is possible and that both parties can learn and enrich each other.