The neurointerventional endovascular fellowship at Penn is an interdisciplinary fellowship including faculty from neurosurgery, neuroradiology and neurology and is SNS/CAST approved. The 2-year program offers comprehensive training in cerebrovascular disease of the brain, neck and spine using both radial and femoral access techniques.
We use state of the art biplane angiography machines in 3 hospitals including 3 hybrid biplane icono Siemens OR rooms in our new hospital (the pavilion). Besides diagnostic cerebral and spinal catheter angiograms our fellows will learn techniques of balloon occlusion test, inferior petrosal sinus sampling, WADA testing and all available techniques for endovascular embolization. These include different mechanical thrombectomy techniques for acute ischemic stroke and stenting for intracranial and extracranial carotid disease; coiling (w/wo balloon- / stent-assist), flow diversion or intrasaccular treatment of aneurysms; embolization of arteriovenous malformations, dural arteriovenous fistulas, cavernous carotid fistulas, middle meningeal artery for chronic subdural hematomas and tumors as well as endovascular treatment for traumatic vessel injuries. In addition, our fellows will receive training in interventional spine including kyphoplasty and other state of the art techniques.
Treatment indications at Penn are made interdisciplinary with our partners in vascular neurology, radiology, neurosurgery and others. We have also a weekly teaching case conference run by our fellows with faculty discussion on indications and treatment options. We treat over 2000 endovascular procedures yearly at Penn and this represents one of the largest cerebrovascular volume in the nation, which will allow our fellows to be best prepared for their faculty position after completion of the fellowship.
Our endovascular fellowship program at Penn consists of 2 years of postgraduate training with a junior and a senior fellowship year. In addition, there may be one or two enfolded additional neurosurgical residents (PGY 6 and PGY3) during part or whole year (see graph). In some scenarios a 1-year postgraduate fellowship may be applicable for candidates completed the required case number in a previously enfolded neurointerventional fellowship year.
There are currently 3 locations for endovascular cases and both junior and senior fellows will cover cases in these locations:
- Hospital of the University of Pennsylvania (HUP), The Clifton Center for Medical Breakthroughs, 3 biplane hybrid rooms, additional biplane rooms – Main site for elective and emergent endovascular cases such as out-/inpatient diagnostic angiograms and treatments, Joint Commission-certified Comprehensive Stroke Center
- Presbyterian Hospital, 1 biplane IR room – Level 1 Trauma Center, inpatient diagnostic angiograms and treatments focused on all neck/head trauma emergencies
- Virtua Our Lady of Lourdes Hospital, Camden New Jersey, 1 biplane hybrid room - Out-/inpatient diagnostic angiograms and treatments, Joint Commission-certified Comprehensive Stroke Center
Junior fellowship year
In the first year the fellow will learn 1) how to set up a catheter angiogram including indication, reviewing preprocedural imaging, risks/benefit discussion with patients, choice of access, positioning, prepping / draping, interacting with nurses / techs, learn PRU / ACT testing, handling radial cocktail other IA medications, patient transport, documentation; 2) how to preform technically a diagnostic angiogram including handling of wires and diagnostic catheters, differences between radial and femoral access, differences of spinal versus cranial angiograms, navigation of wires and catheters, learn robotic assisted angiograms (Corindus); 3) taking primary endovascular fellow call covering endovascular emergencies such as strokes, trauma or neck emergencies (initially with supervision by senior fellow), learning how to set up emergency cases, basics in endovascular treatment such as biaxial, coaxial, triaxial set ups; 4) how to set up and perform interventional spine cases with direct supervision of the faculty 5) assist / the senior fellow / faculty in treatment endovascular cases if the senior fellow is not available or needs assistant.
Senior fellowship year
In the second year focus is on 1) how to set up endovascular elective and emergent treatment cases including reviewing preprocedural imaging, risks/benefit discussion with patients, choice of access, complication avoidance and possible management, documentation and post-procedure management; 2) how to assist/perform treatments with direct faculty supervision including performing microcatheter / microwire technique, handling bi- versus triaxial set ups, decision making and handling of different guide, intermediate, microcatheters including pros and cons for the specific case, performing aneurysm coiling/intrasaccular treatment, flow diversion and different liquid embolic / particle embolization techniques; 3) taking primary endovascular fellow call covering endovascular emergencies such as strokes, trauma or neck emergencies with independent set up of the procedure and performing the procedure with direct supervision of the faculty; 4) perform interventional spine cases more independent with supervision of the faculty; 5) taking on leadership roles including organizing fellows call schedule / weekly case conference, help the junior fellow to be successful.
Neurosurgical residents (PGY 6 and PGY3)
If enfolded residents are present during the rotation of the postgraduate fellows the postgraduate training will be prioritized, but it is expected that both junior and senior fellows will support the resident education together with the faculty by teaching basics of endovascular techniques, access and diagnostic catheter angiography.
All candidates applying to the Endovascular Fellowship Program at Penn must meet all ABMS Specialty board-related eligibility prerequisites required to enter training in the related specialty program and must satisfy the requirements of the State of Pennsylvania Board of Medical Licensure for appointment at the specific level of training for which the position is offered.
In addition, applicants must meet one of the following qualifications to be eligible to apply for the Fellowship Training Program:
- Graduates of medical schools / osteopathic medicine in the United States and Canada accredited by the LCME / AOA.
- Graduates of medical schools outside the United States who meet one of the following qualifications:
- Have received a currently valid certificate from the ECFMG; or
- Have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction.
- Graduates of medical schools outside the United States who have completed a Fifth Pathway program provided by an LCME-accredited medical school.
Applicants must also have completed a residency in neurological surgery, radiology or neurology at an ACGME-approved program in the United States. All prerequisite prior training must be successfully completed prior to beginning the fellowship.
All applications are initially reviewed by the Fellowship Directors, Dr. Jan-Karl Burkhardt and Dr. Bryan Pukenas. The decision to offer an interview to an applicant is made by the Fellowship Directors based upon the following criteria: academic credentials, ability, communication skills, three letters of recommendation, and personal qualities such as motivation, honesty and integrity.
All interviews are conducted in person and the Interviewing Committee consists of all our faculty performing neuroendovascular procedures at Penn.
The Penn Neurointerventional Endovascular Fellowship Program uses ERAS (Electronic Residency Application Service) through NRMP (National Residency Match Program) for our application process. Applications are reviewed in the early spring. If you have any questions regarding the program, please contact:
Kate Petriccione
Medical Education Coordinator
Email: Katherine.Petriccione@pennmedicine.upenn.edu
Susan Small
Residency Program Coordinator
Email: Susan.Small@pennmedicine.upenn.edu
Fellowship directors
Jan-Karl Burkhardt, MD, FACS
Division Head of Cerebrovascular and Endovascular Neurosurgery
The James and Agnes Kim Associate Professor of Neurosurgery
Assistant Professor of Radiology
Co-Director of Neurointerventional Endovascular Fellowship
Bryan Pukenas, MD
Associate Professor of Radiology at the Hospital of the University of Pennsylvania
Associate Professor of Neurosurgery
Co-Director of Neurointerventional Endovascular Fellowship
Supporting faculty
Visish M. Srinivasan, MD
Assistant Professor of Neurosurgery at the Hospital of the University of Pennsylvania
Linda J. Bagley, MD
Associate Professor of Radiology at the Hospital of the University of Pennsylvania
Associate Professor of Neurosurgery
Associate Program Director of the Diagnostic Neuroradiology Fellowship
Robert W. Hurst, MD
Professor of Radiology at the Hospital of the University of Pennsylvania
Professor of Neurosurgery
Current fellows
George Koutsouras, DO
Residency: SUNY Upstate Medical University Hospital
Andrew Ko, MD
Residency: George Washington University Hospital
Yohannes Mulatu, MD
Residency: SUNY Downstate Health Sciences University
Previous fellows
- Alice Hung
- Sonia Ajmera
- Redi Rahmani
- Sandeep Kandregula
- Kelley Flesher
- Suehyb Alkhatib
- Chuan Liang
- Matthew Holkamp
- Hussein Nasser
- Jonathan Ji
- Kofi Atsina-Buaku
- Preethi Ramchand
- Mougnyan Cox
- Pavel Rodriguez
- Neda Sedora-Roman
- Martin Oselkin
- Aaron Bress
- Coung Nguyen
- Neil Patel
- Tim Miller
- Guarav Jindal
- Bryan Pukenas
- Sudakhar Satti
- Shamsher Dalal
- Oleg Bronov
- James Jaffe
- Linda Bagley