Come and join us across the globe
To start the day, Course Directors Jacques Moret, Laurent Spelle (both from France) and Vitor Mendes Pereira (Canada) were joined by Hae Woong Jeong (South Korea) and Michel Frudit (Brazil) to present the follow-ups of the 16 patients treated live in LINNC 2023. Special emphasis was placed on the fact that despite presenting an infarction, clinical outcomes may improve up to 6 months, which in case of apparent re-permeabilization after the use of intrasaccular devices the flow might be flow within the device itself.
This was followed by Daniel Vela-Duarte (USA) presenting the new main trials included in the latest edition of the LINNC Trials Book’s 2024 edition. This underlined the great success of the 2023 edition, and incorporates the most recent evidence of thrombectomy in late time territory (Probe) and LVO, among other topics.
Then Marc Ribó (Spain) presented the interesting experiences of his research center using innovative techniques such as large caliber catheters, cyclic aspiration and contact with thrombus to avoid vessel collapse, as well as the use of double Y-retriever stents for thrombi at the ACM or M2 bifurcation.
We then turned to the special session entitled “Course Director’s Choice Innovation” where Adam S. Arthur (USA) presented the results of the STEM Trial and Jason Davies (USA), the results of the EMBOLISE Trial. These groundbreaking trials explored the use of liquid embolization of the medial meningeal artery and showed excellent results in the treatment of chronic subdural hematoma, with less recurrence than with surgery.
It was now the turn of LINNC faculty member Tommy Andersson (Sweden) to speak about “Stroke imaging today: When, Where and What?” where he helped illuminate many of our doubts and questions about stroke imaging, clarifying that most decisions can be made using CT or angioCT, as demonstrated by MR CLEAN LATE. He discussed as well, the concept that a perfusion study is very useful for the detection of MeVO and that here, MRI can provide additional information, but is not essential.
In the industry sponsored symposium, Vitor Mendes Pereira (Canada) explored the different qualities of the PHILIPS angiography team, which allows for 3D reconstructions, CT vessel, butterfly and dual axis scans with virtually no contrast – and is compatible with OCT.
Then Aymeric Rouchaud (France) showed us the results of the first human series of determination of the clot constitution of the thrombus in vivo, through impedance with the Clotild wire (CLOT OUT study).
Christian Mihalea from Bicêtre Hospital in Paris presented a pre-recorded case of a thrombectomy treated with a NeVa stent retriever. The case had a mild vasospasm which was successfully treated with nimodipine. This opened an interesting discussion concerning which vasodilator agents have the better profile (with Raul G. Nogueira of the USA favoring the use of milrinone for its positive inotrope effect) and whether it is advisable to employ these agents prophylactically.
The industry symposium that followed was presented by Marios Psychogios (Switzerland) demonstrating the advantages of the RED aspiration catheter, especially in the treatment of MeVO.
Another pre-recorded case from Bicêtre Hospital showed the management of a left M1 thrombectomy in a young patient successfully treated with aspiration. It appeared that a carotid web could be seen as the possible cause which opened the discussion on the best treatment in these cases, with Raul Nogueira explaining why he would favor putting in a carotid stent.
Raul Nogueira (USA) then went on to delight us with a masterful presentation on LVO treatment, which showed that although age and ASPECTS are predictors of outcome, they should not necessarily modify our therapeutic behavior. He argued that ASPECTS is not always directly related to the total size of the infarct and that the size only explains 12% of the outcome, while there are other factors that influence the eloquence of the territory, the brain frailty and the "quality" of the infarction.
Finally, he emphasized that treating an LVO improves functionality, decreases mortality and does not increase mRS 5 in any of the recent trials (RESCUE JAPAN, SELECT 2, ANGEL ASPECTS, TESLA, BALLATE, TENSION) and reminded us that if no one doubts that they should treat cardiac or septic shock, they should equally not hesitate to treat stroke as well.
In the last lecture of the day, Markus Möhlenbruch (Germany) spoke about the differences involved in the treatment of recanalization of LVO vs MeVO, with the latter having a higher risk of intraparenchymal or subarachnoid hemorrhage. This led him to recommend the use of special materials and always vacuum in contact with the thrombus for MeVO.
The last pre-recorded case of was from Bicêtre Hospital and showed a mechanical thrombectomy of a left M2 branch successfully recanalized with a Trevo Stentriever.
Now was the moment for the presentation of the “best case” competition which both delighted and challenged the audience. But among the more than 10 cases in the competition one had to be chosen as the winner and that was the case submitted by Pooja Dugani from India. Her case, provocatively entitled “Tangled”, concerning a proximal ICA occlusion, and she allowed us to see how she managed a complication of a tangled carotid stent during the thrombectomy - a case providing lively comments from both the Expert Panel and Course Directors. Congratulations Pooja Dugani for the Best Case Award at LINNC 2024!
As the third day comes to an end, we can vividly recall some of what our faculty taught us over the Course: that we should not be victim to “strokephobia”; that the age of a patient is understood as more than a number and, beyond this that we can advance best, by advancing together – for ourselves, and for our patients.
And so we bring our coverage of LINNC Paris 2024 to an thrilling endnote – we look forward to seeing you next year, or at any of the number of LINNC venues here, online, or throughout the world!
Reported by the Fellow team from Bicetre hospital
Mohamed Abdelaziz
Arthur Gutter
Julia Juhász
Andrés Silva
Felipe Vencato