Come and join us across the globe
Filled with international case studies, with relevant commentary and scintillating debates by the Expert panel…not to mention the participation of the public - it was all happening on day two of the LINNC Paris Course, 2023.
The morning cases begin...
Welcome back for this second day of LINNC Paris 2023!
Let’s start the morning with the first live case of aneurysm treatment from South Korea.
Hae Woong JEONG and his team used an intrasaccular device to treat a wide neck middle cerebral artery bifurcation aneurysm in an 85-year-old patient. The expert panel discussed the importance of patients’ selection on the basis of age, life expectancy and comorbidities. Could Artificial Intelligence contribute to a better patient selection in the near future?
Then it was the turn of Isabelle DEMARRE who gave us an interesting speech about strategies to cope with serious complications in INR. She underlined the importance of attending morbidity-mortality meetings, paying attention to a failure by analyzing the mistakes and sharing with the team our emotions, our solidarity and participating in the team’s cohesion. This is part of our daily practice, something we should not forget!
Now we move to a live case from Paris. In Bicêtre Hospital, another large neck saccular aneurysm of the anterior communicating artery was treated by Laurent SPELLE using an intrasaccular device. A preliminary simulation of the device behavior was assessed before the treatment on a 3D model.
For the third case of the morning, we came back to South Korea and Busan Paik Hospital, where a large dysplastic aneurysm of the distal internal carotid artery, in contact with left optic nerve, was treated with a flow diverter stent. The panel of experts discussed the exact location of the aneurysm together with the challenging anatomy to be addressed along with the technical difficulties found during the treatment. From the ongoing discussion some questions were raised: Should we use additional steroids or statins for large and giant aneurysms?
Symposium Time
The Stryker Symposium led by Mario MARTINEZ-GALDAMEZ saw Brian JANKOWITZ presenting the long-term safety and effectiveness results of the Neuroform Atlas Stent. Then was the turn of Patrick NICHOLSON from Dublin who presented the long-term follow-up of the Surpass Evolve flow diverter. The last talk of this symposium was an interesting one by Monica KILLER-OBERFALZER who compared two of the intrasaccular devices available on the market, the Contour and WEB. Some tips and tricks about their use were analyzed together with current literature available so far. The Salsburg experience was also presented, with satisfactory adequate occlusion rates obtained with both devices.
Innovation session…Let’s see through the wall!
We were approaching the end of the second morning but the standing-room only audience attention remained very high. Vitor MENDES PEREIRA introduced the medical engineer Giovanni UGHI and his presentation about the development of a new endovascular imaging device. Giovanni UGHI showed us a wire-like dedicated intravascular “Optical Brain Imaging” probe of .015”, compatible with .021” microcatheters. He showed the beautiful high resolution cerebrovascular imaging from the inside/out of the vessels, including the fascinating visualization of the perivascular space. What a step forward for our discipline!!
The innovation session was also enriched by Vitor MENDES PEREIRA who shows some cases demonstrating the utility of the advanced endovascular imaging technology applied to our clinical practice. As Jacques MORET just said… we are living in a wonderful world. Really impressive, thanks!
End of the morning…
The morning ended with the second case from Bicêtre Hospital, performed by Laurent SPELLE and his team. A tiny internal carotid termination aneurysm, hidden behind the origin of the A1 segment, was approached with a flow diverter. A trans-anterior communicating artery navigation was performed to obtain the most precise deployment of the stent at the level of the origin of the contralateral A1 segment. What about the long-term follow-up in cases of limited flow diverter landing zone too close to the neck aneurysm? It was Saleh LAMIN who posed the question.
Let’s wait for the follow-up… next year we will have the answer.
The second part of the second day
After the lunch break, the meeting resumed with the Medtronic symposium. Marc RIBO present the initial experience from the INSPIRE-S registry, evaluating the combination therapy using Solitaire and the React aspiration catheter in mechanical thrombectomy. This was followed by an interactive speech led by Jildaz CAROFF animating a discussion on the ideal dual antiplatelet therapy duration following aneurysm treatment with the Pipeline Shield.
Back to Live Cases…
Jacques MORET presented the next case which was performed at Bicêtre Hospital. Laurent SPELLE and his team treated a left side bifurcation MCA aneurysm using the Web intrasaccular device. Once again, this year all the treatments were simulated before they began in order to optimize the planning of both strategy and material choice.
Then we moved to Brazil to assist to another live case from Albert Einstein Hospital (Sao Paulo, Brazil). The team led by Michel FRUIDIT approached a recurrence after more than 20 years from the first surgical clipping treatment of a ruptured bifurcation MCA aneurysm. The chosen strategy was a flow diverter stent. At the Vaso-CT control a lot of artifacts, due to the previous clipping, limited the visualization of a good apposition of the stent to the vessel wall. “This should be the perfect case in which using OCT could make the difference”, suggested by Vitor MENDES PEREIRA.
Now it was time for Jens FIEHLER to present the data coming from the INSPIRE-A registry; a good moment to explain the importance of central angiographic analysis and core lab process standardization to compare outcomes between Vantage Stent and Pipeline Shield flow diverters.
Time for afternoon Symposium
Mario MARTINEZ-GALDAMEZ started the Balt Symposium by presenting the design and preliminary results of the FIRST study, a prospective study about safety and efficacy of Silk Vista and Silk Vista Baby. Then, Francesco BIRASCHI present the results from a retrospective Italian experience regarding the Silk Vista Baby.
Approaching the last two cases of the day
The Bicêtre Team led by Laurent SPELLE treated a “T” carotid aneurysm starting through a radial approach. The treatment strategy foresaw the use of the Trenza endosaccular device to obtain good neck coverage, completing the treatment by an aneurysm filling with regular coils. The instability of the system provided by the radial access led to the decision to change to a femoral approach in order to achieve the final result.
Jacques MORET introduce the last talk of the day which was given by the new Course Co-Director, Vitor MENDES PEREIRA. We listened to an amazing speech about cerebral veins and venous outflow congestion - the new frontier of our discipline.
Finally, the last case of the day brought us back to Sao Paulo, Brazil. From Albert Einstein Hospital there, Michel FRUIDIT treated an anatomically challenging wide neck large aneurysm of the distal carotid artery with the Pipeline Vantage flow diverter.
Another day comes to an end
We spent an intense and fruitful day together!
We are looking forward to meeting you again for Day 3 of LINNC Paris 2023!
See you tomorrow.
Valerio Da Ros