From stroke to complex cases and beyond – Day 3 of LINNC Paris 2018

As we began the third and final day of LINNC 2018 we were still filled with fresh memories of the previous evening’s fantastic reception at the Louis Vuitton Foundation with magnificent views of Paris.

This third day was dedicated to our hot topic of stroke and started with a major question: “Who should perform thrombectomy?”. The question – and its answer – is a complex one, but we were assisted by the presentation of Emad Kadi from Egypt who presented the guidelines, challenges and special skills necessary for being an efficient interventional neuroradiologist instead of becoming what Jacques Moret has characterized as a  “thrombectologist”. The discussion concerned what will be the future for thrombectomy with constructive exchanges between world stroke leaders. There is a strong need to develop practice and training standards for certification in the new interventional neuroradiology specialty, something that was presented by Italo Linfante for the USA and Christophe Cognard for European practice.

Professor Spelle starting the clinical presentations

Then Professor Spelle started the clinical presentations with pre-recorded acute stroke thrombectomy cases from the NEURI center in Bicetre, France.
The first recorded case was an M1 occlusion treated with an Embotrap device with complete recovery. The main teaching point of this case was the management of a femoral access leakage and how to manage these types of complications which could be dramatic in case of retroperitoneal hematoma. One option, which brought up pros and cons in the discussion that followed, was to approach stroke patients through radial access.

Then Mayank Goyal discussed off-label indications for mechanical thrombectomy, focusing on the end of “time from symptoms onset” as the main selection criteria. The discussion was also about diagnosis of the occlusion level directly in the ambulance in order to choose quickly whether to send the patient to the local or comprehensive stroke center. M. Goyal also discussed the keen interest in simulation in order to train neurointerventionalists for stroke.

The second recorded case reported on an MCA occlusion with Sofia Plus and Solitaire platinum using the bare wire technique for increased distal aspiration. The clinical occlusion was not favorable, despite rapid and efficient recanalization, which brought up a discussion about the futility of recanalization in some patients – TICI 2B versus TICI 2C recanalization – as well as the benefits of using a balloon guided catheter.

Peter Mitchell then presented a literature update regarding thrombolysis which focused on tenecteplase.

Moving from stroke to aneurysms, Francis Turjman and Salvatore Mangiafico animated the Cerenovus symposium with a presentation of the PulseRider for the treatment of wide neck bifurcation aneurysms.

A third recorded stroke case illustrated an ICA occlusion with a fragmented clot retrieved with the maximalist combined approach using the Stryker arsenal. Even if first-pass recanalization is the aim, this case illustrated that we should never end up with the case of a reluctant clot, and that even after six passages the game is worth playing!

Tudor Jovin spoke about tools to minimize door to reperfusion time. He discussed admitting patients directly to the angiosuite for one-stop management of acute stroke patients with perfusion CT performed directly in the angiosuite itself.

Recorded case from LINNC Paris 2018

The last recorded case of the day was an MCA occlusion performed by Cristian Mihalea with a distal aspiration using the Sofia Plus catheter. This case raised the question about recanalization for low NIHSS score with a proximal occlusion. This was the subject of further discussion thanks to a presentation by Laurent Pierot who emphasized the ongoing RCT especially IN EXTREMIS which should provide the answer.

For the Microvention Symposium, Markus Möhlenbruch presented the results of the EuroFRED study. This was followed by Laurent Spelle, who presented for the very first time at LINNC, the results of the CLARYS study evaluating the efficiency and safety of WEB devices for ruptured aneurysms. This study, including 60 ruptured aneurysms, reported a 0% re-bleeding rate at one month, with 1.7% mortality and 15% morbidity with no morbidity related to the device, as adjudicated by an independent corelab.

LINNC 2018 ended with several clinical cases presented by attendees and extensively discussed with the experts as well as the presentation of the follow-up of all the patients treated during last year’s LINNC 2017.

 

Once again, this LINNC edition was a formidable opportunity to share with the entire community. Together we discovered new devices and updated our current knowledge as well as considering the future directions of our tremendous specialty!

We thank you all for your presence at this 21st edition and we will be pleased to welcome you next year in Paris for a new edition of the LINNC… June 3 -5 2019!

Before then, don’t forget our annual meeting for LINNC Asia in Singapore on November 16-17, 2018 and also our USA Edition for 2019 which will be taking place for the first time in Miami, Florida from March 22 to 23 2019!

Looking forward to see you there, and of course, here, everyday, at LINNC online!

Dr Rouchaud

 
Aymeric Rouchaud