Interventional Radiology in Sikkim, Northeast India

Downloaded from www.ajronline.org by 3.86.10.138 on 09/29/21 from IP address 3.86.10.138. Copyright ARRS. For personal use only; all rights reserved Letters Interventional Radiology in Sikkim, Northeast India We read with great interest the recent article by Madhusudhan et al. [1] on interventional radiology (IR) in India. Although the stated purpose of the article was to review the status of IR in India, it also provided an ex- cellent overview of the history of and future directions for this niche subspecialty. The authors reported that around 75 centers are performing vascular and nonvascular radiologic interventions in the country but mentioned only two centers in the northeast, in Guwahati and Shillong [1]. We would like A B Fig. 1—Patients with aneurysm of anterior cerebral artery. A, 54-year-old man with aneurysm of A1 segment of anterior cerebral artery. Angiogram shows coil embolization of aneurysm. Solid black arrow indicates coils in aneurysm. Solid white arrow denotes proximal marker of microcatheter. Open black arrow indicates distal access catheter. Open white arrow denotes guiding catheter. B, 60-year-old man with ruptured aneurysm of anterior communicating artery. Angiogram shows coiled aneurysm (arrow). A Fig. 2—52-year-old woman with bleeding pelvic pseudoaneurysm, low hemoglobin (4 g/dL). A, Angiogram shows N-butyl cyanoacrylate (NBCA) injection by selective catheterization of uterine artery. Black arrow indicates NBCA in pseudoaneurysm. White arrow indicates microcatheter. B, Angiogram shows right common iliac artery injection after embolization. Arrow indicates NBCA cast. B to draw the authors’ attention to a third regionally important institute: Central Referral Hospital in Gangtok, a 500-bed tertiary care hospital with 22 specialties and state-of-theart equipment. The department of radiodiagnosis was established at the inception of this hospital in 1999. Over time, the department has grown tremendously and is now able to perform 64-MDCT, color Doppler sonography, 1.5-T MRI, and 1000-mA digital radiography. It also has catheterization laboratory facilities with a dedicated neuroimaging and interventional radiologist. The hospital is affiliated with Sikkim Manipal University, a public-private university, as part of its institute of medical sciences and caters to a large regional population. Recently, Diplomate National Board seats with a 3-year course for postgraduate teaching in radiodiagnosis were also approved and started in this institute. Over the last 2 years, approximately 500 nonvascular and 170 vascular IR procedures (Figs. 1 and 2) were performed at the facility, including abscess drainage, percutaneous nephrostomy, percutaneous transhepatic biliary drainage, transarterial chemoembolization, peripheral angioplasty, sclerotherapy, radiofrequency ablation of varicose veins, diagnostic cerebral angiography, coil embolization of intracranial aneurysms, mechanical thrombectomy for acute ischemic stroke, preoperative tumor embolization, and aspiration thrombectomy for cerebral venous sinus thrombosis. The overall success rate of was 99% for diagnostic procedures and 95% for therapeutic ones. The periprocedural minor complication rate was 1–2%. No procedure-related mortality or major complications occurred. These statistics are comparable with the literature of independent practice in suburban setups in India [2]. The terrain and public awareness of the potential IR treatments were major impediments to the establishment and progress of the specialty in this part of India. The volume of procedures performed reflects the efforts of the radiology team as a whole and the wider acceptance of interventional procedures by physicians. Hence, we believe the IR map of AJR 2019; 212:W120–W121 0361–803X/19/2125–W120 © American Roentgen Ray Society W120 AJR:212, May 2019 Downloaded from www.ajronline.org by 3.86.10.138 on 09/29/21 from IP address 3.86.10.138. Copyright ARRS. For personal use only; all rights reserved Letters India in Figure 2 of the article by Madhusudhan et al. [1] is incomplete without the inclusion of Gangtok. IR, including neurointerventional procedures, is being increasingly performed with satisfactory outcomes in various parts of India and increased public awareness is required to ensure its optimal utilization for various diseases. Teaching programs need to incorporate specific training in IR to ensure adequate availability of specialists to perform these lifesaving procedures in all remote corners of the country. AJR:212, May 2019 Shriram Varadharajan Kovai Medical Centre & Hospital Coimbatore, India Subhendu Parida Care Hospital Hyderabad, India Gorky Medhi Sikkim Manipal Institute of Medical ­Sciences Central Referral Hospital Gangtok, Sikkim, India gorkymedhi@gmail.com doi.org/10.2214/AJR.18.20889 WEB—This is a web exclusive article. References 1. Madhusudhan KS, Srivastava DN, Sharma S, Sharma S. Interventional radiology in India. AJR 2018; 211:730–735 2. Kumar S. Endovascular neurointervention success and complication rates in the first year of independent practice in a suburban hospital setup. J Neurosci Rural Pract 2014; 5:11–17 W121