Treating challenging aneurysms – live from China, Chili and around the world and back to Paris in a day of sharing experience…and community!
The second day of LINNC Paris 2019 started with four challenging aneurysm live cases from China – a first for LINNC. The team managed by Professor Hongqi Zhang demonstrated in a step by step fashion the technique of “twice deployment” of a PED flow diverter to treat a paraophthalmic aneurysm of a very tortuous carotid siphon giving better stability and precision in positioning the stent.
They then treated two aneurysms: a carotid-ophthalmic aneurysm and a middle cerebral artery aneurysm employing a “stent remodeling” technique. A braided stent was partially deployed over the aneurysm neck to assist coiling before the definitive detachment of the stent. The subsequent audience discussion centered around the advantages of using this technique. The fourth case was the treatment of a giant posterior cerebral artery aneurysm with flow diverters.
Professor Fady Charbel gave the morning lecture on a method of quantitative blood flow MR angiography (NOVA-QMRA) and its clinical applications.
We then saw the first of the day’s life cases from Bicêtre hospital in Paris with Professor Laurent Spelle treating a recanalized AComm aneurysm with a daughter sac at its neck by placing a new low profile flow diverter, the SILK Vista Baby, from A2 to homolateral A1. This provided the occasion to discuss the best “stenting strategy” based on anatomical considerations, the subject of a recent paper published by Igor Pagiola from our team at Bicêtre. As in the following aneurysm cases, the Sim&Cure software proved to be very useful in order to size the implant to obtain the desired proximal landing zone.
The French physicist and philosopher Etienne Klein shared with us his considerations on the nature and our perception of the concept of “Time”, followed by Professor Spelle concluding the morning session with a complicated deep AVM treatment by the venous route. This case highlighted the importance of hyper-selective injections of afferent arteries to clearly understand the anatomy of the malformation by avoiding superimposition with normal vessels.
The afternoon session began with the third life case from Bicêtre, a patient with two irregular aneurysms at the terminal aspect of the ICA. Both were embolized with WEB devices with balloon assisted placement (a “WEB-remodeling” technique). Using this opportunity, Dr Vanessa Chalumeau demonstrated the possible applications of the HoloLens, an augmented reality device facilitating the understanding of a given anatomy by repositioning work in a “real-time” environment.
The fourth and last life case from Bicêtre saw Professor Laurent Spelle treating a carotid siphon aneurysm with a Surpass Evolve flow diverter.
The day concluded with two interesting live cases performed in Santiago de Chili with the team managed by Doctor Rodrigo Rivera.
First, the treatment of a giant intracavernous aneurysm with a very long SILK Vista flow diverter placed through a Copernic balloon in order to realize an angioplasty, if necessary, immediately after deployment, of the proximal aspect.
We then witnessed a Chilean variant of the “pressure-cooker” technique in a dural AVM that was embolized with Phil 25 from the arterial route injected through an inflated Scepter balloon.
With the work well done and the clinical discussion behind us, we enjoyed a moment together at the evening’s LINNC 2019 reception. This took place at the Musée National Picasso, which has a beautiful collection of this painter’s works, this time with a special exhibit along with Alexander Calder.
Good company, a magnificent Parisian setting – and looking forward to joining you at Day 3 of LINNC Paris!
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