Welcome to the third day of LINNC Paris 2023 – a day dedicated to Stroke with challenging cases and a look into the future!

This was followed by a presentation from Jean-Marc Olivot (Toulouse, France) who updated us on a hot and much awaited topic: “Large-core infarcts (ASPECTS 3-5), how could we select patients for the thrombectomy?” He highlighted the three recent positive trials (RESCUE-JAPAN, ANGEL, and SELECT-2), which selected patients with ASPECTS 3-5, as well as a recent negative one presented during ESOC 2023, the TESLA Trial, which was the only one that also included patients with ASPECTS 2. Hemorrhagic rates, except for SELECT-2, were higher in the thrombectomy group. Is advanced imaging (perfusion) still an option for large vessel occlusion strokes?

Then, Vitor Mendes Pereira (new Co-Course Director from Toronto, Canada) gave an interesting talk about the state-of-the-art in 2023 on intracranial artery disease (ICAD), evidence and management. He mentioned some technical pearls, and after this, Raul Nogueira (Pittsburgh, PA, USA) gave an outstanding lecture.

And have you looked at your beautiful LINNC pink bag? Inside you have a printed book with all the recent trials in our field! Laurent Spelle (Course Director from Paris, France) took a moment to thank Daniel Vela Duarte (Palm Beach, FL, USA) for the fantastic work he did in editing this book.

After the coffee break, Italo Linfante (Miami, FL, USA) gave us an inspiring talk about Phase 1 HEMERA-1. This randomized clinical study evaluates the safety and the effects of a single IV administration of PP-007 (pegylated bovine carboxyhemoglobin) on collateral flow, infarct size, and functional outcome in patients admitted with acute ischemic stroke. In the future, can we stimulate collateral development through medication?

This is one topic you should definitely keep your eyes on.

Sponsored symposiums and a fine end to the third morning

In a sponsored symposium presentation, we entered a highly interesting topic: cone-beam CT in stroke. This was presented by Vitor Mendes Pereira, Nicole Cancelliere, and Carlos Bleise (Toronto, Canada). How can we use cone-beam CT in the acute stroke scenario? In the sequence, Aymeric Rouchaud (Limoges, France) gave a lecture highlighting what we should pay attention to in challenging thrombectomies cases (first pass effect, length of the thrombus, ICAD etiology) and how the new Clotild Smart Guidewire technology (CLOT OUT trial) could help in these challenging cases. Here we are speaking about a guidewire with the ability to tell us what the composition of the thrombus is while crossing the occlusion.

Co-Course Director Vitor Pereira started with a recorded posterior circulation stroke case from Saint Michael’s Hospital, Toronto, Canada. It was a basilar ICAD case performed by his fellow. We discussed complications and decisions in a very difficult situation. Undoubtedly, something that it is very much necessary in a neurointerventionalist’s career.

Laurent Spelle continued with a recorded stroke case from Bicêtre Hospital, of a left carotid occlusion artery with patent communicant artery. A large bore aspiration catheter was used and although a TICI-2c was obtained, there was a floating thrombus at the origin of the internal carotid artery at the end of the procedure. The patient was referred to endarterectomy, but he had a worsening of symptoms at day 2, post-procedure. Would you have treated it with a stent in the acute phase? Dr Raul Nogueira proposed aspiration with a balloon guiding catheter. Could you think of another possibility?

In the next sequence, Ricardo Hanel (Jacksonville, FL, USA) gave us an inspiring lecture about the “Future of Acute Stroke Treatment: Where we will be in 5 years”? He went through neuroprotection, direct to angiosuite thrombectomy, strategies to improve recanalization (bigger and better aspiration catheters, smart guidewire system), and robotics. The future is bright and “The best way to predict future is to build it”! Amazing insights.

Back to recorded cases

Jonathan Cortese showed a recorded stroke case of a tandem occlusion in Bicêtre Hospital, and he showed the use of a mobile application called “Stroke View”. The stroke was caused by an atheroma and a stent was placed in the carotid artery, with the use of IV cangrelor acute anti-aggregation. Prof Spelle developed a very nice discussion regarding the transition of IV cangrelor to ticagrelor 180mg.

Last, but not least: The Best Case Award

If you remember, we started with the case presentations. And yes, there was a winner (although all the cases were quite amazing and inspiring, elucidating nice discussions).

Emilio Lozupone had presented an interesting case of dural arteriovenous fistula in the sphenoparietal region (type III Cognard). Igor Pagiola (São Paulo, Brazil) showed a challenging treatment of a brain AVM using the transvenous pressure cooker technique. He reinforced the importance of 3D to better understand venous anatomy.

Boris Pabon (Medellin, Colombia) presented a case of a giant ICA aneurysm with a very challenging proximal to a distal microcatheter. He explored complications and reinforced the importance of keeping endovascular procedures within the shortest time-frame possible. The longer the procedure, the higher the risk of complications. Nanthiya Sujijantarat (New Haven, CT, USA) presented a complex osteodural fistula of the anterior skull base with venous treatment through the facial vein. Sukru Oguz (Trabzon, Turkey) shared a case of a rare condylar anterior dural fistula, highlighting the importance of understanding venous anatomy.

Read Day 1

Read Day 2