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We hope you enjoyed a beautiful “Paris by night” yesterday! And once again today we met up in the early morning at the Carousel du Louvre for DAY 2, where we discovered interesting cases and how to manage difficult situations among friends!
Prof. Jacques Moret began the day by presenting the first live case from Gleneagles Global Hospital in Mumbai, India which featured a blister-like superior hypophyseal artery “ruptured” aneurysm treated with a flow diverter. This was a good example of how sometimes it remains difficult to determine the relationship between bleeding and the presence of a small intracranial aneurysm!
The experts discussed the rationale behind making the good decision in order to determine the indication, including – in this context – the role of wall vessel imaging.
For the second live case, we moved to Bicêtre Hospital in France where Prof. Laurent Spelle dealt with an anterior fossa dural fistula treatment. The strategy foresaw the use of an arterial approach. A clear understanding of the anatomy of the ophthalmic artery remains mandatory in order to secure a successful endovascular treatment in this case. The expert panel also suggested that microsurgery and a transvenous approach would also be very good options when faced with this situation.
It was now time for Dr Edoardo Boccardi to speak about a case of a type I arteriovenous fistula which illustrated what we call at LINNC “the dark side of our discipline”.
Despite the inflation of a balloon catheter to protect the sinus, the inferior temporal vein occluded during the embolic agent injection causing a large intraparenchymal bleeding.
Indications for treatment, the type of embolic agent to be used and, most importantly, when to stop injection, are fundamental aspects to take into account in order to limit this infrequent but potentially fatal complication.
The morning program continued with another case from Mumbai, this time treating a complex fusiform ruptured aneurysm with a bleb observed at the level of the supraclinoid carotid artery. The operator’s choice was a flow diverter stent deployment.
How much protection from re-bleeding does flow diversion provide in the acute phase?
The expert panel helped us understand how to proceed and what would be the most suitable strategy to pursue.
Then our Course Director introduced the Innovation Session in which Drs Adnan Siddiqui and Frédéric Clarençon spoke about telerobotics for stroke treatment – something that could definitely change patient access to Mechanical Thrombectomy!
It was then the turn for Bicêtre Hospital to offer us another Live Case, this time with Dr Jildaz Caroff leading the team. Here we saw the management of a small broad neck “pyramidal” aneurysm of the PcomA which was treated using a new generation of coils.
The expert panel offered the participants some tips on coiling, including the importance of shaping the catheter. The presence of placing a balloon has demonstrated several advantages, not only for bleeding protection but also by helping in the catheterization of the sac and stabilizing the microcatheter.
The afternoon went very fast, enriched as it was with other great live cases!
It started with a small ruptured medial temporal AVM treated at Bicêtre Hospital using a transvenous approach with Prof. Laurent Spelle showing us the tips and tricks for a successful treatment.
This was followed by the treatment of multiple carotid aneurysms with a single flow diverter stent by Dr. Pascal Jabbour.
But Day 2 wouldn’t be complete if it was not for a very interesting presentation by Prof. Raul G. Nogueira regarding the brain computer interface. This is a system which is able to record voluntary brain activities and translate them into commands…!
Yes, welcome to the future my friends, the sky is the limit!!
But now, after all this excitement and learning, the time has come for a well-deserved cocktail and to enjoy the unforgettable Paris with friends and colleagues.
Cheers!
Reported by Valerio Da Ros