[neuro_imager]

For the sake of completeness, I'll expand:

It's rarely up to the interventionalist if and when they will treat a stroke. There are clear guidelines on treating these patients (which mostly take place at comprehensive stroke centres), mostly defined by the neurology service, which functions somewhat independently. These guidelines have been expanding as newer evidence has shown a role in wider time windows but this point remains the same. There is very little opportunity for an individual interventionalist to increase his patient volume independently (at least for ischemic stroke).

I agree in principle with most of the points you make, although I think perverse incentives are largely a function of the US healthcare system in general rather than the domain of any particular specialty.

In specific relation to the original article, I'm extremely doubtful that combing two anti-thrombotic agents would be a miraculous therapeutic regime for treating stroke but I'd be happy to be proved wrong by a legitimate trial. However, I'd worry that we'd be sacrificing patients that could otherwise be treated if we assigned them to an arm of a trial that precludes established therapy.