From Paris to Mumbai to Houston – Day 2 at the 25th anniversary edition of LINNC Paris 2022!

After a first day filled with very interesting cases and instructive discussions, Dr Jildaz Caroff opened the second day of this year’s LINNC edition with a very interesting lecture about the heterogenicity in the use of antithrombotic drugs. Dr Caroff spoke about this heterogenicity across different INR units as well as among physicians in the same unit, highlighting the need to elaborate guidelines ideally based on randomized studies, just as is the case in cardiology.

Off to India

The first live transmission of the day was from Mumbai. Prof. Udaye Limaye performed is first live case treating a recanalized giant MCA bifurcation aneurysm by additional coiling and parent vessel reconstruction with a braided Leo stent and a flow diverter. This gave the expert panel the occasion to discuss alternative treatment techniques involving a technically challenging bypass surgery followed by parent vessel occlusion.

And from Paris

The second case of the day was from Bicêtre Hospital. Prof. Laurent Spelle treated an irregular aneurysm in a very tortious ICA siphon aneurysm with a flow diverter p64 MW. Once again, this demonstrated the precious assistance afforded by Sim&Cure software for stent sizing and prediction of the proximal landing site, as well as by providing an overlay in real time to aid in delivering the stent.

Prof. Udaye Limaye performed is first live case treating a recanalized giant MCA bifurcation aneurysm

In addition, this case demonstrated the difficulty of placing a flow diverter in tortuous vessels, whereas the conception of the device with a hypotube pusher and an independent wire was supposed to insure better stability and trackability. Nevertheless, the price to pay would be a higher device profile.

After the coffee break, the Mumbai team led by Prof. Limaye presented a difficult case of a bilateral carotid siphon with a fast-evolving stenosis in a young diabetic patient, discovered after a right deep MCA territory stroke with regressive neurological deficit. The symptomatic side was treated by angioplasty with a Gateway balloon and stented with a drug eluting Synergy stent, a coronary stent. This gave rise to a discussion about the indications and risks of placing a stent in non-atheromatous stenotic lesions, since we do not clearly understand the evolution of these lesions.

A moment with Industry

Before retuning to live cases, Rich Cappetta was invited to speak on the complex relationship between industry and government and its impact on innovation and on INR.

The Stryker sponsored symposium focused on stroke treatment with Prof. Markus Möhlenbruch presenting first results from the ASSIST registry. Dr Paul Bhogal spoke as well, describing his center’s experience with an AI powered imaging system and how that can contribute to patient selection for mechanical thrombectomy and facilitate the creation of stroke treatment networks. 

A return to live cases

Meanwhile, the team from Bicêtre hospital led by Professor Laurent Spelle, prepared for their second live case of the day, a complex septal AVM with intranidal aneurysms. After careful analysis of the angioarchitecture and the flow competition with the help of a new prototype program enabling the real time overlay of DSA images from different arteries, Prof. Spelle planned to perform a targeted treatment of the compartment at risk by transarterial Onyx injection. Even if the Onyx penetration was not as expected, the initial goal could be achieved with the Onyx refluxed from the neighboring to the target compartment. This inspired the expert panel to discuss whether or not you should leave the patient under heparin for several days; a position advocated by Prof. Moret, even if we are lacking scientific evidence, because, in his experience, many complications after AVM embolization arise from thrombosis of draining veins.

The afternoon session started with an industry sponsored symposium by Medtronic focusing on successive generations of the PED device and the first experience with radial access using the RIST system presented by Dr Rita Rautio. The results of the prospective cAVM registry of cerebral AVMs treated with Onyx was presented by Prof. Christophe Cognard.

Two live cases from the Houston team led by Prof. Orlando Diaz

To jail or not to jail – that is our question

During the afternoon session, we witnessed two live cases from the Houston team led by Prof. Orlando Diaz. He demonstrated how pre-treatment simulation with the Sim&Cure software followed by training on a specifically tailored Biomodex flow model could help in planning treatment as well as in the selection of appropriate tools.

The first case was an incidental ACom aneurysm treated with a FRED Jr flow-diverter and the second case was a very tricky wide neck MCA aneurysm in a patient with a tortuous ICA intended to be treated by Y-stenting with Atlas stents and coiling through a jailed microcatheter. The latter case gave rise to a panel discussion as to whether to jail or not a microcatheter inside the aneurysm. Prof. Moret advised always starting with the most angulated branch for Y-stenting.

Back in France

Meanwhile, in Bicêtre Hospital, the afternoon was dedicated to aneurysm treatments by radial access. First, Prof. Spelle treated an MCA bifurcation aneurysm with an intrasaccular Contour device through a distal radial access at the snuffbox level demonstrating the delicate sizing of the device.

The last Bicêtre live case was a recurrent ACom aneurysm that Prof. Spelle treated with a flow diverter from the proximal radial route. The treatment was assisted by a prototype program allowing for the real-time superimposition of a Sim&Cure simulation on the fluoroscopy, facilitating stent positioning.

In the last industry sponsored symposium of the day, Prof. Aymeric Rouchaud spoke on how biological surface modification may optimize flow diversion in the future by sharing with us his fundamental research results on this subject.

LINNC is 25 years young!

The day was crowned by Prof. Moret’s tribute to the first quarter century of the LINNC adventure: from its early beginnings to the format it has taken on today.

And what better way to celebrate than sharing a nice moment at the LINNC social reception which took place at the Musée d’Orsay!

 

Now it’s time to join us tomorrow….at LINNC Paris 2022 for a third and thrilling day of educational sessions!

 

Leon IKKA

Leon Ikka

 

This LINNC Paris daily report is supported by

BALT