2026 Interventional Neurologist Salary Guide: Stroke Thrombectomy & Neuroendovascular Compensation

Interventional neurology — formally Neuroendovascular Surgery (NES) or Endovascular Surgical Neuroradiology (ESN) — is among the fastest-growing and highest-compensated neurological subspecialties in medicine. Practitioners perform catheter-based procedures for stroke (mechanical thrombectomy, tPA delivery), cerebral aneurysms (coil embolization, stent-assisted coiling, flow diversion), arteriovenous malformations (AVM embolization), carotid stenosis (carotid artery stenting), and intracranial atherosclerosis. The subspecialty draws physicians from three training pathways — neurology, neurosurgery, and neuroradiology — and is governed by United Council for Neurologic Subspecialties (UCNS) certification. Total compensation in 2026 runs from $450,000 to $850,000+, with call-driven income supplements reflecting the 24/7 nature of acute stroke intervention.

Salary overview by practice setting

• Academic comprehensive stroke center (CSC): $450,000–$650,000; NIH NINDS stroke and vascular neurology research; UCNS/CAST fellowship training; highest-complexity case mix (giant aneurysms, complex AVMs, basilar occlusions); PSLF-eligible; stroke outcomes research and clinical trial infrastructure
• Hospital-employed neurointerventional practice (community CSC): $550,000–$800,000; no research requirement; high-volume mechanical thrombectomy program; wRVU-based with call stipend; employed model at community comprehensive stroke centers serves the largest volume of acute stroke intervention nationally
• Private/independent neurointerventional group: $650,000–$900,000+; rare outside of large urban markets; typically hospital-contracted rather than truly independent; full wRVU retention; call coverage premium; some groups contract with multiple hospitals for neurointerventional coverage (regional model)
• Multi-specialty neurovascular program (neurology + neurosurgery combined): $600,000–$850,000; integrated open neurovascular + endovascular team; complex case collaboration (hybrid open/endovascular approaches); highest-acuity case volumes attract the most complex referrals nationally

Training pathways and credentialing

Neuroendovascular surgery has three recognized training pathways, each requiring fellowship after primary residency:

• Neurology pathway: Neurology residency (4 years) → vascular neurology fellowship (1 year) → neuroendovascular fellowship (1–2 years); UCNS certification in Neuroendovascular Surgery; growing pipeline as stroke neurology creates natural career progression to intervention
• Neurosurgery pathway: Neurosurgery residency (7 years) → cerebrovascular/endovascular fellowship (1–2 years); ABNS board certification in neurosurgery + UCNS NES certification; historically dominant pathway; neurosurgeons bring open surgical and endovascular dual scope
• Neuroradiology pathway: Radiology residency (4 years) → neuroradiology fellowship (1 year) → neurointerventional fellowship (1–2 years); ABR board certification + UCNS NES certification; imaging expertise adds value in complex diagnostic-therapeutic decisions

All pathways require UCNS Neuroendovascular Surgery examination for subspecialty certification. Programs credentialing neurointerventionalists typically require minimum case volume thresholds (50–100 mechanical thrombectomies, 50 intracranial aneurysm cases) for initial privileging — a credentialing moat that limits rapid market entry.

Procedures and CPT billing

Neurointerventional procedures command among the highest CPT reimbursements in catheter-based medicine. The combination of high-complexity vascular work, diagnostic angiography, and interventional procedures generates significant per-case professional fees:

• Mechanical thrombectomy (acute ischemic stroke): CPT 61645 (percutaneous arterial transluminal mechanical thrombectomy, brain); professional fee $3,500–$7,000; the highest-volume acute interventional neurology procedure; stent retriever (Solitaire, Trevo, Embotrap) and aspiration catheter techniques; time-sensitive (door-to-recanalization target <60 minutes); 24/7 on-call coverage requirement drives call stipend structure; anterior circulation (MCA, ICA) and posterior circulation (basilar artery) occlusion indications
• Diagnostic cerebral angiogram (4-vessel): CPT 36221 (right common carotid) + 36222/36223/36224 (selective catheterization with angiography); professional fee $2,000–$4,500 for complete diagnostic cerebral angiogram; the gold standard for vascular anatomy evaluation; standalone procedure for aneurysm surveillance, AVM characterization, vasculitis evaluation
• Intracranial aneurysm coil embolization: CPT 61624 (transcatheter occlusion or embolization, intracranial); professional fee $5,000–$10,000; endovascular packing of cerebral aneurysm with platinum microcoils; balloon remodeling (balloon-assisted coiling, CPT 61626 add-on) or stent-assisted coiling (CPT 61635 add-on) for complex anatomy; alternative to open surgical clipping (CPT 61700); endovascular treatment now preferred for the majority of ruptured and unruptured aneurysms based on ISAT trial data
• Pipeline embolization device (flow diverter): CPT 61624 (intracranial embolization); professional fee $5,000–$10,000; plus device-specific add-on codes; flow diversion for large/giant or fusiform aneurysms not amenable to coiling; Medtronic Pipeline, MicroVention Surpass, Balt Silk Vista; requires separate stent retriever training and proctoring; growing adoption as device iterations improve deliverability
• AVM embolization (intracranial): CPT 61624 (embolization) + 75894 (fluoroscopic guidance); professional fee $5,000–$10,000 per embolization session; Onyx liquid embolic agent or NBCA glue; multi-session treatment for complex AVMs prior to radiosurgery or open resection; Spetzler-Martin grade IV–V AVMs require multidisciplinary management
• Carotid artery stenting (CAS): CPT 37217 (carotid stenting, extracranial, with distal embolic protection); professional fee $3,500–$7,000; alternative to carotid endarterectomy (CEA) for symptomatic or asymptomatic carotid stenosis; CREST trial defined appropriate patient selection; Wingspan stent for intracranial atherosclerosis (CPT 61635)
• Intracranial atherosclerosis angioplasty and stenting: CPT 61630 (balloon angioplasty, intracranial) or 61635 (intracranial stenting); professional fee $4,000–$8,000; high-risk procedure reserved for symptomatic patients with ≥70% stenosis refractory to medical management; SAMMPRIS and VISSIT trial data define the risk-benefit tradeoff; practiced at comprehensive stroke centers
• Venous sinus thrombosis treatment: CPT 37195 (intracranial thrombolysis); professional fee $3,000–$6,000; cerebral venous sinus thrombosis with neurological deterioration despite anticoagulation; catheter-directed thrombolysis or mechanical thrombectomy; rare but high-complexity
• Spinal cord arteriovenous malformation embolization: CPT 61624 (embolization) with spine location modifiers; professional fee $4,000–$8,000; spinal dural AV fistula embolization; technically demanding; rare presentation but high functional impact

Call structure and stroke program requirements

Mechanical thrombectomy efficacy is time-dependent (DAWN, DEFUSE-3 trials show benefit up to 24 hours from last known well, but outcomes improve linearly with faster recanalization). This requires 24/7 interventional capability at comprehensive stroke centers. Call structure implications:

• Call stipend: $80,000–$200,000 annually at busy comprehensive stroke centers; reflects the physical and logistical burden of 24/7 call with frequent overnight cases; stroke thrombectomy demand is growing as stroke centers proliferate and treatment indications expand
• Call sharing: Programs with 3–6 neurointerventionalists share call (1 in 3 to 1 in 6); smaller programs (1–2 physicians covering all call) report highest burnout and attrition
• Telestroke and spoke-hub models: Regional comprehensive stroke centers take thrombectomy transfers from primary stroke centers (PSC) that can administer tPA but cannot perform thrombectomy; this hub-and-spoke model concentrates thrombectomy volume at comprehensive centers, increasing per-physician call volume but also increasing per-physician wRVU production

Geographic variation

• Major academic neurovascular programs (Mayo, Stanford, UCSF, Hopkins, Columbia, Penn, NYU, Cleveland Clinic): $460,000–$680,000; research infrastructure; complex AVM and aneurysm referrals; neurosurgery + neuroradiology + neurology collaboration
• Regional comprehensive stroke centers (community, high volume): $600,000–$850,000; employed model; high-volume thrombectomy; call-intensive; strong call stipends
• Sun Belt markets (FL, TX, AZ, GA): $580,000–$830,000; high stroke burden in aging populations; growing comprehensive stroke center investment; telehealth-facilitated stroke triage expanding thrombectomy access in these markets
• Emerging and rural markets: $550,000–$800,000; hospitals building stroke programs require established neurointerventionalists to credential the program with JCAHO and maintain program status; above-market compensation offered to attract qualified physicians to non-traditional markets

What we see at Ava Health

Neurointerventional physicians are among the most actively recruited specialists in our database. The combination of limited fellowship pipeline, 24/7 call requirements driving burnout at under-staffed programs, and rapid proliferation of new comprehensive stroke center designations creates persistent demand. The physicians most open to outreach are those carrying unsustainable call burdens (1-in-2 or 1-in-3 at programs without adequate neurointerventional coverage) and those at academic programs considering community moves for significant compensation improvements. The critical evaluation criterion on the candidate side: call share, stroke volume, and whether the program has a dedicated catheterization suite with 24/7 technician backup (without reliable overnight IR tech backup, case logistics become a significant burden).

Related: Neurologist Salary Guide, Neurosurgeon Salary Guide, Radiologist Salary Guide, Vascular Surgeon Salary Guide.