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Creation of training and credentialing standards for cervicocerebral angiography, angioplasty, and stenting, published in this issue of Neurology,1 acknowledges an important reality: the cardiologists are coming. A force of over 4,500 interventional cardiologists,2 having already moved from the heart to the renal and peripheral arteries, having stood up to cardiothoracic surgeons and won, is rapidly moving into the arteries of the neck and brain, which partisans of the clinical neurosciences considered sacred. Of over 12,000 stents placed in carotid arteries in the United States last year (Dan Tuden, Boston Scientific, personal communication), approximately one quarter were put in by cardiologists.3 Why is this happening? Are the carotid arteries large blood vessels, just like so many others in the body, or are they special? Who should be allowed entry into patients’ carotid arteries?
The idea of cardiologists treating carotid disease may at first seem as indefensible as neurologists performing sternotomies, but there are several justifications that must be recognized. First, cardiologists are knowledgeable about …
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