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The second day of LINNC Paris 2025 began with an insightful case presented by Laurent Spelle, featuring a procedure led by Markus Holtmannspötter and his team from Nuremberg General Hospital. The team tackled a challenging left dysplastic fusiform M2 aneurysm using a flow diverter, carefully strategizing to preserve the temporal branch in this right-handed patient. The initial strategy emphasized how coiling and anchoring a short landing zone with a laser-cut stent might be great ways to stabilize challenging flow diverter cases. In the end, the flow diverter was perfectly stable, without the need for any extra metal, and the temporal branch, while covered, retained great flow and calibre.
Next came the eagerly anticipated Course Director’s Choice Innovation session, where Christophe Cognard presented on the provocative topic: “Lead-Free Neuroradiological X-Ray Procedures: Myth or Reality?”. Groundbreaking results were presented, indicating that such lead-free procedures may soon become a viable reality, significantly reducing the physical burden of traditional lead protection.
The second live case of the day came from Bicêtre Hospital, led with precision by Vanessa Chalumeau, and the treatment of a duro-arachnoidal AVF was tackled through an arterial approach. A masterclass in how thorough anatomical study pre-treatment, and protective measures such as an ICA balloon and careful reflux control might be the key to smooth and safe procedures.
In the sobering “Dark Side of INR” session, Isil Saatci bravely showcased how many unanswered questions remain in the treatment of giant aneurysms. Should you opt for a staged treatment? When should you add coils to flow diversion? Can individualized study of the thrombus, or of the wall of the aneurysm be the key?
The next live case, presented by Markus Holtmannspötter and his team from Nuremberg General Hospital, focused on the delicate management of a dural fistula in a patient without cortical venous reflux, a situation where risk minimization is paramount. Checking for feeders that might become angiographically visible during the procedure was highlighted in the discussion.
But in the end, closing the “foot of the vein” allowed Markus’ team to achieve a perfect result.
The second Bicêtre case of the day, led by Laurent Spelle, showcased a nuanced approach to aneurysm management. Prof. Spelle masterfully placed an Artisse in a wide-neck right MCA bifurcation aneurysm, and concluded by stressing the critical role of simulation in endovascular planning, underscoring its value in optimizing outcomes for complex aneurysm cases.
The Course Director’s Choice of Innovation session continued with a captivating presentation by the pioneer and endovascular legend Alejandro Berenstein. The presentation left the audience in awe at the potential of articulating catheter technology to redefine endovascular control and precision in every procedure.
During the lunch break, the spotlight turned to the eagerly awaited Clinical Cases Contest awards ceremony. Congratulations to the standout presentations by Fortunato Di Caterino and Samer Al-Ali, as they added an inspiring note to the midday session.
The afternoon sessions resumed with the third live case of the day from Bicêtre, led by Laurent Spelle. He showed how the new eCLIPs device with flow diversion properties might be an elegant solution in top-of-ICA aneurysms. The discussion stressed the importance of first catheterizing the most challenging branch to ensure optimal control throughout the procedure, and how precise marker positioning to plan the landing zones might be key to achieving a device placement as perfect as what we saw on the final vasoCT of this case.
We then moved all across the globe to the first live case from the Toronto team at St. Michael’s Hospital, performed by Danni Diestro. The team tackled a challenging right MCA aneurysm with an important perforating branch arising directly from the sac. Due to the aneurysm’s size and angulation, positioning the Contour was technically demanding, requiring meticulous orientation to ensure optimal protection of both the aneurysm dome and the parent artery. The team’s primary goal was to achieve secure coverage of the sac while preserving critical branches, showcasing advanced techniques and thoughtful planning in this intricate scenario.
The Course Director’s Choice New Frontiers session featured a dynamic presentation by Elad I. Levy, entitled “Neurointervention in Ambulatory Centers: Our Future Is Now.”. Levy emphasized the critical importance of proper case selection to ensure patient safety and successful outcomes in this new outpatient paradigm, and showed us how the future belongs to the bold and the brave.
The fourth live case of the day from Bicêtre Hospital was led by Jildaz Caroff and focused on the delicate management of a shallow wide-neck bifurcation aneurysm, a scenario fraught with technical challenges. He emphasized the value of ensuring strong support and catheter stability, and elegantly demonstrated how device selection and technique can be adapted to meet the demands of even the most challenging aneurysm anatomy.
The final live case of the day came once again from the Toronto team, with Danni Diestro at the helm. The team treated a large right ICA aneurysm with a Surpass Evolve. In a challenging, tortuous, proximal curve, he showed us how it pays off to trust the cobalt-chromium design of the Evolve to pop and properly expand during deployment, a confidence that was well-rewarded in this successful case.
The day ended with the legendary Pedro Lylyk showing us a glimpse into the future: the treatment of subdural hematomas through transvascular access of the subdural space. Lylyk’s vision left the room buzzing with excitement and curiosity—underscoring yet again how the field of neurointervention continues to push boundaries and redefine what is possible.
Hugo Cadilha
Hospital de Santa Maria,
Lisboa, Portugal
