June 15th, third day at LINNC Paris 2017
After an amazing reception organized by the LINNC committee at the Musée des Arts et Métiers, the morning session of the third and last day began with a multidisciplinary brainstorming session focused on the acute phase management of acute ischemic stroke (AIS) patients. Didactic but challenging cases presented by Dr O. Chassin, vascular neurologist (Bicêtre, France) and Dr N. Chausson, vascular neurologist (CHSF, France), launched the debate on the most compelling subjects. Then Dr. Aghasaryan, vascular neurologist (CHSF, France), reviewed the evolution of the AIS management and the latest data from the literature over the last 2 years.
This was followed with a recorded case, presenting the setting of a patient with difficult access. Different strategies were discussed. BCG is largely recommended to improve the clinical outcome of patients, but for now there is no evidence of improved benefit in combined proximal and distal aspiration techniques.
Next, we had the pleasure of welcoming one of the experts from the MRCLEAN team: Wim H. Van Zwam from Maastricht, The Nederland, who highlighted unpublished results of the MRCLEAN REGISTRY. How to improve your decision-making and anticipate the long-term benefit of MT, new tools and improvement in what is involved in our understanding of prognosis were discussed.
Then, Profs J. Moret and L. Spelle presented a recorded case of a proximal M1 occlusion responsible for a large volume ischemia. A new pump from Stryker was presented with an efficient suction force and the ability of easily picking up the clot. The clinical relevance of large infarct core recanalization and the reversibility of DWI lesions are still being debated.
The presentations continued with Raul G. Nogueira, Atlanta, USA, presenting the DAWN study results in “wake-up” or patients who present later after the stroke has occured. The mismatch consisting of substantial clinical deficits but small infarct size is the major criteria to consider in patient selection. A long applause followed his revolutionary conclusion: “Time should no longer be a disqualifier for thrombectomy!”
The third recorded case of the day was presented by Prof. L. Spelle. The recent introduction of large bore aspiration catheters into our therapeutic armamentarium enlarged the choice of the best technique to use based on the clot burden or the nature of the thrombus.
Next came, Prof. C. Cognard from Toulouse, France, who presented an analysis of tandem occlusion management, which is a real concern in our current practice. Early endovascular management of cervical occlusions has to be motivated by the risk of recurrence depending on the presumed etiology of the AIS. There is still no consensus on which is the better approach.
To conclude this very interesting morning, Prof. L. PIEROT, Reims, France, offered his expertise on the selection criteria and subgroup analysis of recent literature, leading to a better understanding of who could benefit from mechanical thrombectomy.
A casual Lunch was served in the Carrousel du Louvre before continuing the day.
The early afternoon began with a symposium presented by Prof. A. Bonafé, Montpellier, France, concerning the second generation hydrogel-coated coils randomized trial. Then, Prof. L. Pierot lectured on the clinical results from WEB trial.
The day ended with a round table of discussions concerning a variety of cases presented by international LINNC online members covering the whole field of our specialty. There was plenty of talk on stroke, AVFs and the setting of large neck aneurysms using intrasaccular devices as well as the latest generation of stents.
Surrounded by friends, LINNC Paris celebrated its 20th anniversary in a three-day course that was less ceremony and more an opportunity for critical discussion. We watched first-hand the experience in challenging cases from all over the world: this year from Mumbai (India), Paris (France), Moscow (Russia) and Toronto (Canada). This exceptional meeting brought together over 850 specialists from every country and from every generation all of whom are dedicated to the treatment of intracranial vascular diseases.
For 20 years, LINNC has been the guardian of a disciplined and informed sense of expertise in our specialty. It has helped give us the confidence to know that each of us can change the way of dealing with intracranial vascular pathologies. We believe that the cooperation of international teams and the open exchanges and sharing of clinical expertise and knowledge will have the power to face the challenge of every situation…and forge the appropriate solutions for our patients.
We wish you all a good return to your homes and hospitals and look forward to seeing you all again in Singapore for the second Asia Edition of the LINNC Seminar which will take place later this year on November 17-18.
Thank you all for your active participation.
See you next year!