Stay up-to-date with the latest in INR, and get expert advice on neurovascular management - join us at Day 3 of LINNC Paris 2022!

As we began the third and final day of LINNC 2022, we were still filled with fresh memories of the previous evening’s fantastic reception at the Orsay Museum with sweeping views of Paris.

Experience is the best teacher, so sharing this experience is essential. This third day was dedicated to the latest research and news in treating stroke, with this year having a special focus on posterior circulation strokes and complications.

A day of learning begins
The day began with the presentation of the French ETIS observational registry of over 15,000 patients with Dr Bertrand Lapergue emphasizing the importance of collaborative data collection about stroke management. This large ongoing prospective observational EVT registry is a powerful academic research tool, provides effective stroke device evaluation and, when completed, will allow us to assess and improve stroke care.

It is probably the future of trials.

presentation of the French ETIS observational registry of over 15,000 patients with Dr Bertrand Lapergue

Facing complications

Complications were sharing in the morning session. We the audience, were placed in the role of the decision maker, and were confronted with some “real life” difficult situations which allowed us to come together and examine the causes and consider alternative courses of action – which allowed us to come up with a set of recommendations.

The first recorded acute stroke thrombectomy cases from the NEURI center in Bicêtre, France presented an M1 occlusion treated with a pRESET LUX device with near complete recanalization. At the beginning it looks like an easy case, a case that should take 2 minutes, but at every step, complications occurred: dissections, cervical spasms, difficult pressure monitoring, groin complications. The main teaching point of this case was “never underestimate your enemy and always be prepared”.

recorded case from Bicêtre concerned a distal M2 occlusion

The next stroke recorded case from Bern, Switzerland was presented by Dr Pasquale Mordasini. We have all faced tough clots, thrombectomy resistant clots, and there is no well-defined management. The faculty explored the underlying issues, comparing different alternatives, and suggested courses of action in light of recent knowledge.

Later, Dr Marc Ribo presented new evidence for intra-arterial lytics after MT that could be an answer to incomplete recanalization. The expert panel discussed how, as new information becomes available, changes in our practice are needed.

The next recorded stroke case from Bicêtre was a basilar tip occlusion treated with thrombo aspiration using a Penumbra catheter by distal transradial access. This was a good technical presentation of how to perform a thrombo aspiration.

It was also a good introduction to the next lecture.

The second recorded case from Bicêtre concerned a distal M2 occlusion. The patient presented with a very high NIHSS and was treated with the NeVa stent retriever with a very good result. This apparently difficult case associated with a poor neurological outcome was perfectly managed with the efficient tools that have been developed thanks to the partnership with industry.

Basilar artery occlusions

Dr Raul Nogueira, on behalf of his co-investigators led by Wei Hu from Hefei, China, delivered the results of the ATTENTION Study concerning MT for basilar artery occlusion in an early time window. We welcomed the already expected message that the overwhelming efficacy of EVT persists in the posterior circulation!

The Chinese team achieved a tremendous accomplishment, collecting an enormous amount of data regarding BAO patients treated with actual techniques and using the most effective devices.

Then Dr Tudor Jovin delivered late-breaking results from the Chinese BAOCHE trial. Improved good outcomes and lower mortality rates with EVT versus BMM supported the ATTENTION study’s findings. The benefit of EVT management persisted for late-presenting BAO patients as it was demonstrated in the anterior circulation.

The discussion turned to what would be the future role for BAO thrombectomy with constructive exchanges between these world stroke leaders.

first result from CLOT OUT study

Innovations

Now came the time to explore innovations. Collaboration between industry, clinicians and patients is essential to fully understand and address current challenges, enabling the technology to realize its full potential. Dr Monica Killer-Oberpfalzer presented the future successful development of robotics applied to EVT.

And because endovascular thrombectomy is no longer just about removing the clot, we are proud to present the first result from CLOT OUT study. Using Clotild, a smart guidewire that integrates Sensome’s artificial intelligence–powered tissue sensor, clot characteristics are available in live real-time during the intervention, which can help to increase our chances of choosing the right approach to obtain a first pass complete recanalization.

We have many aspirations of what we hope can be accomplished with these technologies.

Clots and occlusions

Dr Ray McCarthy perfectly illustrated the difficulties of removing a tough clot which depends on their composition.

His presentation was followed by Dr Mohamed Aggour who completed the Cerenovus symposium with an excellent demonstration of technical solutions in front of complex occlusions.

Cases and more Cases

After the lunch break, three recorded stroke cases from Bicêtre presented difficulties encouraging questions about low NIHSS, dissection management, acute ICAD, distal BAO.

Dr Ray McCarthy perfectly illustrated the difficulties of removing a tough clot which depends on their compositio

This was followed with more case discussions presented by the wonderful LINNC attendees who came from Australia, Sweden and Slovakia, but also from Chicago, New Jersey and New York in the USA and Turkey, India and France. Dural fistula, dissecting aneurysms, AVMs, anatomy, physiopathology, innovative strategies and salvage therapy were extensively discussed with the experts.

A special congratulations went to Dr Rashmi Saraf for her case of unilateral proptosis revealing an arteriovenous metameric syndrome (CAMS) which was wonderfully managed. At the end, Prof. Laurent Spelle presented the follow-up of all the patients treated during last year’s LINNC Paris 2021.

Looking forward to our next LINNC!

This 25th LINNC edition was an amazing moment for sharing, learning and to give thanks for so many years of building and reinforcing our community.

Together we exchange experience and knowledge and accomplish so much as we look forward to the future of our tremendous and always evolving specialty!

 

Vanessa Chalumeau

Vanessa Chalumeau

 

 

This LINNC Paris daily report is supported by

BALT