Member Board of the American Board of Medical Specialties

RFP: CNS Neuroendovascular Surgery

Over the course of the next 4 review cycles CESAC will be collecting actual case data submitted by applicants in order to better understand evolving practice patterns in neuroendovascular surgery.

Specifically total case volumes will be analyzed for frequency of the various endovascular procedures performed.

Currently, the CESAC committee will continue to diligently review each application, holistically evaluating case complexity and volumes.

Recognition of Focused Practice in CNS Endovascular Surgery

This RFP has been approved by the ABMS and has the goal of recognizing candidates who have successfully completed a(n) standardized neuroendovascular training program and met practice criteria, thereby elevating and advancing patient care for the public good. This RFP is co-sponsored by The American Board of Psychiatry and Neurology (ABPN) and American Board of Radiology (ABR).

The CESAC committee reviews applications twice per year.

RFP in CNS-ES Credentialing: CESAC

Credentialing of RFP candidates will be performed by CESAC (Credentialing Endovascular Surgery Advisory Committee). CESAC is responsible for credentialing neurosurgeons, neurologists, and radiologists who have completed training in a CAST, ACGME, or UCNS Fellowship or through a clinical practice pathway. CESAC will have equal membership of endovascular subspecialists approved by the ABNS, ABPN, and ABR. The term of service is 3 years renewable one time for a total of 6 years. The size of the committee is flexible and will be determined by CESAC reflecting the workload and voluntary efforts of the membership.

CESAC is charged with: 1) writing the cognitive exam (ABNS will refer to this exam as the RFP Endovascular Examination), 2) writing an annual adaptive learning tool module to be given in conjunction with member board continuous certification requirements, 3) determining the details of the required practice data submission (both initial and annual) and the metrics by which that data is approved or denied, and 4) recommending approval of individuals for RFP in CNS-ES to their respective Boards.

Candidates who successfully 1) pass the RFP Examination and 2) have an approved application will be awarded the printed credential.

The application must be submitted by the candidate to ABNS and include the following:

  • Completed application which will include:
    • Certificate of successful completion of CNS-ES Fellowship accredited by ACGME, CAST, or UCNS.
    • Evidence of unrestricted medical license.
    • Credential to practice from the chief medical officer of current hospital practice.
    • Two letters of recommendation from peers that must include confirmation of focused endovascular practice.
  • A passing score on the RFP Endovascular Examination (administered by the ABNS), taken after completion of the fellowship.
  • Practice Data submission: A minimum of 250 interventional treatment procedures with 40 aneurysm treatments (10 ruptured); 20 intracranial AVM/AVF/Tumor embolizations; 25 intracranial/extracranial stents with at least 5 of each; 30 acute stroke treatments; 10 intracranial infusions for vasospasm, stroke, or chemotherapy; 10 extracranial embolizations; and 5 spinal angiograms or embolizations.

Click here for information on how to apply.

The recommended study material for the CNS Endovascular RFP exam is below (not intended to be exhaustive):

Neurointerventional Techniques (Tricks of the Trade) by Cameron McDougall and others (Thieme publishing)

Decision Making in Neurovascular Disease by Elad Levy, Adnan Siddiqui and others (Thieme publishing)

Diagnostic Cerebral Angiography by Anne Osborn (LWW publishing)

Any/all recent stroke publications

Requirements for Neurosurgeons Completing Endovascular Fellowship

  1. Completed application.
  2. Satisfactory completion of an ACGME neurosurgery residency which includes at a minimum ABNS requirement of 6 months of NICU training.
  3. ABNS board eligible, “tracking towards certification.”
  4. Satisfactory completion of a CNS-ES fellowship accredited by either the ACGME (known as Endovascular Surgical Neuroradiology [ESNR]), Committee on Advanced Subspecialty Training (CAST), or UCNS (known as Interventional Neurology).
  5. After completing your fellowship, cases must include… at least 250 proctored interventional treatment procedures with 40 aneurysm treatments (10 ruptured); 20 intracranial AVM/AVF/Tumor embolizations; 25 intracranial/extracranial stents with at least 5 of each; 30 acute stroke treatments; 10 intracranial infusions for vasospasm, stroke, or chemotherapy; 10 extracranial embolizations; and 5 spinal angiograms or embolizations.
  6. A passing score on the RFP Endovascular Examination (administered by the ABNS).

Requirements for Neurologists Completing Endovascular Fellowship

  1. Completed application.
  2. ABPN certification in Neurology or Neurology with Special Qualifications in Child Neurology.
  3. ABPN certification in Vascular Neurology or Neurocritical Care; or United Council for Neurologic Subspecialties (UCNS) certification in Neurocritical Care.
  4. Satisfactory completion of a CNS-ES fellowship accredited by either the ACGME (known as Endovascular Surgical Neuroradiology [ESNR]), Committee on Advanced Subspecialty Training (CAST), or UCNS (known as Interventional Neurology).
  5. After completing your fellowship, cases must include… at least 250 proctored interventional treatment procedures with 40 aneurysm treatments (10 ruptured); 20 intracranial AVM/AVF/Tumor embolizations; 25 intracranial/extracranial stents with at least 5 of each; 30 acute stroke treatments; 10 intracranial infusions for vasospasm, stroke, or chemotherapy; 10 extracranial embolizations; and 5 spinal angiograms or embolizations.
  6. A passing score on the RFP Endovascular Examination (administered by the ABNS).

Requirements for Radiologists Completing Endovascular Fellowship

  1. Completed application.
  2. AABR certification via one of three pathways:
    1. ABR certification in Diagnostic Radiology (DR) followed by ABR subspecialty certification in Neuroradiology (NR) after completion of ACGME diagnostic neuroradiology fellowship,
    2. ABR certification in Interventional Radiology/Diagnostic Radiology (IR/DR) after completion of Neurointerventional Radiology (NIR) pathway IR/DR residency. This NIR pathway has been defined and includes the prerequisites for a one-year NES fellowship. These are described in the CAST and ACGME program requirements as a minimum of the following 4-week rotations during internship and integrated IR residency: two blocks of Neuro ICU (NICU), two blocks of Neurosurgery (NS), one block of Vascular / Stroke Neurology (VSN), one additional elective block of either NICU, NS, NIR, or VSN, six blocks equivalent of diagnostic Neuroradiology (of which at least 5 blocks are formal diagnostic Neuroradiology rotations), and three blocks of Neurointerventional Radiology, or
    3. ABR certification in Interventional Radiology/Diagnostic Radiology (IR/DR) followed by independent prerequisite pathway as described in ACGME and CAST requirements.
  3. Satisfactory completion of a CNS-ES fellowship accredited by either the ACGME (known as Endovascular Surgical Neuroradiology [ESNR]), Committee on Advanced Subspecialty Training (CAST), or UCNS (known as Interventional Neurology).
  4. After completing your fellowship, cases must include… at least 250 proctored interventional treatment procedures with 40 aneurysm treatments (10 ruptured); 20 intracranial AVM/AVF/Tumor embolizations; 25 intracranial/extracranial stents with at least 5 of each; 30 acute stroke treatments; 10 intracranial infusions for vasospasm, stroke, or chemotherapy; 10 extracranial embolizations; and 5 spinal angiograms or embolizations.
  5. A passing score on the RFP Endovascular Examination (administered by the ABNS).

Practice Track Application Pathway
Clinical Practice Pathway:

Current neuroendovascular physicians are eligible to achieve RFP credentialing through a practice track pathway regardless of whether they trained in a CAST, ACGME, UCNS, or another type of fellowship by completion of the following steps:

Clinical Practice Pathway for Neurosurgeons:

  1. ABNS certified or tracking towards certification.
  2. Completion of non-accredited fellowship training or equivalent clinical experience.
  3. A passing score on the RFP Endovascular Examination (administered by the ABNS).
  4. Clinical Practice Pathway requirements must include at least 50% of the participating candidate's time for at least two years spent in the assessment, clinical management, and procedural care of patients with cerebrovascular disease who are eligible for CNS-ES procedures. Candidates in the Clinical Practice Pathway will be required to document experience with the same type and number of cases as listed above for those in fellowship training over two years. The applicant must have a busy interventional clinical practice with sufficient procedural numbers as determined by CESAC.
  5. Licensing and credentials review.
  6. Two peer letters of recommendation attesting to the candidates' endovascular qualifications.
  7. Participation in ABNS Continuing Certification including the annual ABNS CNS Endovascular module.

Clinical Practice Pathway for Neurologists

  1. ABPN certification in either Neurology or Neurology with Special Qualifications in Child Neurology.
  2. ABPN certification in Vascular Neurology or Neurocritical Care accredited by the ACGME; or UCNS certification in Neurocritical Care.
  3. Submission of the candidates' consecutive case list of two full years of clinical practice experience in CNS-ES for review and approval by a Subcommittee of CESAC. These cases which will include demographic information and key images will be submitted through ABNS Post.
  4. Licensing and credentials review.
  5. Two peer letters of recommendation attesting to candidates' endovascular qualifications.
  6. Clinical Practice Pathway requirements must include at least 50% of the participating candidate's time for at least two years spent in the assessment, clinical management, and procedural care of patients with cerebrovascular disease who are eligible for CNS-ES procedures. Candidates in the Clinical Practice Pathway will be required to document experience with the same type and number of cases as listed above for those in fellowship training over two years. The applicant must have a busy interventional clinical practice with sufficient procedural numbers as determined by CESAC.
  7. A passing score on the RFP Endovascular Examination (administered by the ABNS).
  8. Participation in ABPN Continuing Certification including annual ABNS CNS Endovascular module.

Clinical Practice Pathway for Radiologists

  1. ABR certified with subspecialty certification in Neuroradiology or Interventional Radiology.
  2. Completion of fellowship training or equivalent clinical experience.
  3. Clinical Practice Pathway requirements must include at least 50% of the participating candidate's time for at least two years spent in the assessment, clinical management, and procedural care of patients with cerebrovascular disease who are eligible for CNS-ES procedures. Candidates in the Clinical Practice Pathway will be required to document experience with the same type and number of cases as listed above for those in fellowship training over two years. The applicant must have a busy interventional clinical practice with sufficient procedural numbers as determined by CESAC.
  4. A passing score on the RFP Endovascular Examination (administered by the ABNS).
  5. Licensing and credentials review.
  6. Two peer letters of recommendation attesting to the candidates' endovascular qualifications.
  7. Participation in ABR Continuing Certification including annual ABNS CNS Endovascular module.

CAST Conversion to ABNS RFP in CNS-ES Designation for Neurosurgeons, Neurologists, and Radiologists

Individuals who have an existing CAST endovascular credential can covert to an ABNS RFP in CNS-ES designation as follows:

  1. Completed application.
  2. Licensing and credential review.
  3. Letter of recommendation from Chief of Staff/Chair attesting to endovascular focused practice.
  4. Participation in MOC/CC including annual CNS Endovascular module.
  5. Submission of practice data may be required by CESAC.
  6. The window for CAST certificate conversion ends December 31, 2023.

*If the candidate is a neurosurgeon they must pass the ABNS oral exam which must include a session on endovascular medicine.

Continuing Certification Requirements for ABNS RFP in CNS Endovascular Surgery

Continuing recognition in this 10-year time limited RFP will be consistent and fulfill each member board's requirements, including:

  1. Maintain Primary Board Certification through ABNS, ABPN or ABR.
  2. Documentation of full participation in MOC/CC per the requirements of primary (and secondary boards).
  3. Proof of unrestricted certification(s).
  4. Proof of unrestricted medical license(s).
  5. Proof of unrestricted staff privileges in each hospital at which the applicant practices.
  6. Successful passing of CC Part 3 annual CNS-ES learning tool/ RFP specific module offered via ABNS (on-line).
  7. Evidence of participation in CC Part 4 practice improvement such as Morbidity and Mortality Conferences; national registries (e.g., RedCap NVI, N2QOD NVQI, or other quality registry compliant with Patient Safety Organization requirements); continuous quality improvement activities within a certified stroke center; and/or clinical research (e.g., IRB-approved use of HDE devices, IRB-approved sponsored clinical research, NIH-sponsored multi-center clinical trials).
  8. Cases may be selected to be entered into ABNS Post for peer review. Participants should demonstrate that their practice is actively FOCUSED, by submitting streamlined evidence (patient identifier, date of service and CPT code) that they performed 65 endovascular cases of which 20 cases must be for interventions for the 12-month period in question. The ABNS will audit 1% of participants. The ABNS will provide an online templated form to support this collection which will take minimal time for completion.
  9. Annual attestation that practice remains focused.
  10. A one-year grace period may be extended for completion of these requirements without revocation or suspension of the RFP, with potential diplomate review by CESAC.

ABNS position on fellowships

Individuals who received a CAST certification in CNS Endovascular can convert that credential to a Recognition of Focused Practice in CNS Endovascular Surgery. To do so, an application must be completed and submitted to the ABNS for review and approval. Click here to access the application.

In order to register for the RFP examination, an application must be, at least, started.
To complete and submit an application please login at https://applications.abns.org/ If this is the first time visiting this site, follow the steps in the upper right corner to register.

Once registered follow the steps below to access the application:
Select “Applicant”
Click “Programs” in the black bar
Select “ABNS Recognition of Focused Practice Application: CNS Endovascular Surgery”

Click “More”
Select green “Apply” button