Mayank Goyal1, Crystal M. Yan2
1Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; 2JNI Editorial Office, AME Publishing Company
Correspondence to: Crystal M. Yan. JNI Editorial Office, AME Publishing Company. Email: jni@amegroups.com
Editor’s note
From 24th to 27th, 2024, the 24th Oriental Conference of Interventional Neurovascology (OCIN 2024) was successfully held in Shanghai, China. This conference is designed for neurosurgeons, interventional neuroradiologists, neurologists, endovascular surgeons, residents, nurse practitioners, physician assistants and interventional technicians, and other health care professionals with a special interest in the field of management of neurovascular diseases and will be directly applicable to their daily practices.
As the official journal of OCIN, Journal of Neurointervention (JNI) held a launch ceremony(Figure 1) at the opening ceremony of the conference and held the first editorial board meeting(Figure 2) on the afternoon of the 26th.
Figure 1 The launch ceremony of Journal of Neurointervention
Figure 2 JNI’s editorial board meeting
Also, we were glad to have this chance to conduct an interview with Prof. Mayank Goyal, from University of Calgary, Calgary, Alberta, Canada.
Expert’s introduction
Mayank Goyal is a Clinical Professor in the Department of Radiology and Clinical Neurosciences at the University of Calgary. He is a Diagnostic and Interventional Neuroradiologist at Foothills Medical Centre. Dr. Goyal’s passion and main research interest is acute stroke imaging, workflow and intervention. He has over 300 publications in peer-reviewed journals including first/senior author publications in NEJM, JAMA, Lancet, Lancet Neurology, Radiology. He has close to 100 papers in Stroke. Mayank has led and continues to lead efforts at evidence-based medicine through worldwide randomized controlled trials. He has been part of several successful CIHR and HSF grants. He is a Fellow of Canadian Academy of Health Sciences, Canadian Association of Radiology, American Heart Association and European Stroke Association. He has received Lifetime contribution to research awards from Canadian Association of Radiology and American Society of Neuroradiology.
Interview (Video 1)
JNI: You gave us a speech on Update on MeVO trials. Would you briefly summarize the key points for the experts who did not have the opportunity to attend this conference?
Prof. Goyal: It's a pleasure to be here and pleasure to be back here in Shanghai. MeVO as you know stands for Medium Vessel Occlusion. We are at just around the corner of the two trials we named the trial ESCAPE-MeVO, which was across the world, across Western Europe and across North America. That trial is over and we are finishing up with our 90-day outcome. And there's another a Swiss-German trial called Distal, which is over as well. Both these trials are we'll know the results imminently and they will be presented at the International Stroke Conference. So, it's not a long wait ahead. I know that both the trials have been in the process of thinking about publication so that their publications can come out in February 2025. There are a few other trials, for example, there is DISCOUNT trial in France, they're a little bit behind. So obviously what happens to the trial will be dependent on what happens to the results of DISTAL and ESCAPE MeVO. So, it's a short wait ahead we should know the results imminently. Once we know the result, we learn from it. That's how science goes, and we learn from that scientific process and move on.
JNI: As the Director of Imaging and Endovascular treatment at the Calgary Stroke Program, what are some of the most challenging aspects of this program, and how have you addressed them?
Prof. Goyal: We've been very fortunate over the last 10 years on multiple different fronts. Our field has undergone a revolution in terms of thrombectomy. We've been in the middle of it and leading many of the trials in Calgary. So, it's been a very fortunate time. And the other part that has happened as a consequence of that is that we've been able to attract super-smart people from all over the world. Our team has become bigger and bigger and bigger and we are able to take on bigger projects. But at the same time, we get limited by we are now a big team. How do we keep everyone's academic career going? How do we think about the next big questions? How do we get sufficient resources for doing trials? And doing trials has become more and more expensive over a period of time. Also, in the trials, so to speak, all the low hanging fruit is already gone and the future trials will not have the same degree of effect size, which means we'll need bigger sample size. So, if you need bigger sample size, we need to have more cooperation across different centers in the world and we need to sort of have more amount of money available. That is something which will become the biggest challenge going forward. In the meantime, we are also starting to work on how can we sort of speed up trials. What are the methodologies around it? What are the limitations in the way that we are currently doing the trials? Is there a different outcome measures that we can use? Are there imaging biomarkers that can be used for this process? So, all these things are happening simultaneously, but I must say that the last 10 years have been very, very exciting.
JNI: What motivated you to pursue a career in Clinical Neurosciences?
Prof. Goyal: I think when I was going back, this is many, many years going back, but I do think all parts of the human body we understand, brain is the least, whether you can compare it to the liver, the stomach or the heart. So, to me, it was sort of the biggest mystery in terms of brain. Even today, there are many aspects of the brain that we have zero understanding of. As an example, consciousness, we just don’t know how consciousness works and how does it come about? Even simple things like speech, we have limited understanding of it. So, part of the reason why I came into neuroscience was we didn't understand it enough. And then I moved on to clinical neuroscience career and started doing work in the field of stroke. Because that made sense. Even way back then, I remember giving a talk in 1999 where I was already thinking about that if we can open up the vessel faster, it should improve outcomes. And, I must say over the last 25 years, it's been sort of a great interesting journey where we have made a lot of progress, but at the same time, we still have a very long way to go. We tried two different trials with neuro-protection. Unfortunately, they did not work out. But at the same time, I do think over the next 10-20 years, we have to find a way to make neuro-protection work. Because that is going to be the next big thing once the thrombectomy is fully settled, that is the way to improve outcomes further.
JNI: Do you have any suggestions for young doctors and students working in or interested in this field?
Prof. Goyal: Couple of different things. One is that, you know, those days of old when you could think in a room, come up with ideas and execute them are over, which means pretty much everything will have to be teamwork. So, as you're younger and get into this field, if you're interested in building an academic career, you will have to cooperate with different centers and different people across the world. I truly mean across the world, and right now there seems to be this thing of Western Europe and North America. But we have to get past that and operate at a World level rather than a Western Europe or North America level and cooperate with all countries across the world. The second part that there is that we still have to be conscious of quality and not be in a hurry to do stuff. So, make sure to never compromise on quality and do it in a way that is exceedingly high-quality research that you produce. Always remember, Quality over Quantity.
JNI: Other than being a co-author of more than 200 peer-reviewed articles, you also took up various professional roles. How do you manage your time and energy?
Prof. Goyal: There's no short answer to this question. You just work hard. The two tricks are you just work very hard and surround yourself with super-smart people.