March 17th is St. Patrick’s day in New York and the whole city was celebrating as we began the second day of the LINNC Seminar, US edition from the center of Manhattan. However, our first case did not came from Dublin at all, but from Mexico! Dr D. Bonifacio presented a very unusual dural AV fistula associated with a ruptured aneurysm on one of the arterial feeders. Reactions from the audience were diverse and participants were divided on the nosology of the malformation but everybody agreed with Dr Dulce Bonifacio’s conclusion (see the picture!).
Tandem occlusion management is far from being codified.
It was, as often during these stroke meetings, the source of infinite and challenging discussions. Multiple strategies proposed by the faculty included: Whether to treat proximal or distal occlusions? Whether to use stenting or angioplasty? What would be the best choice, distal or proximal protection? Aspirin, Plavix or Ticagrelor? And more….
For Pr. Jacques Moret, at the heart of these discussions “there is no science …but rather an open exchange of experience”.
We then saw one of the pre-recorded cases. A 66-year-old female presenting with a 7mm MCA aneurysm – How would you treat???
Today, the faculty’s answer to this question was not at all clear: ISUIA and the Phases score? Can this help physicians advise their patients and make the best decision?
Pr. Jacques Moret presented a recorded case of the latest modification of the “remodeling technique” he had initially described in the 1990s: balloon assisted WEBing!
Would you use the MAFA flow analysis provided by the Philips Healthcare system devices to assess the probability of occlusion and eventually deliver a second stent? Toronto’s Dr Vitor Mendes Pereira would and we saw why!
The last session of recorded cases focused on stroke treatment.
Large vessel occlusions associated with very low NIHSS are one of the last clinical situations where the superiority of the mechanical thrombectomy has yet to be demonstrated. As raised in the discussion by faculty member Dr Tudor Jovin, the answer might come from the IN-EXTREMIS trial initiated by the team in Montpellier, France.
For the first time this year, the very best clinical case submitted by attendees was rewarded during the meeting by all faculty members! A fine way to complete an excellent two days of learning and discussion.
We are truly honored by all the positive feedback we received from attendees.
The response has been overwhelming and now the challenge is even greater: We not need only to continue as we have in the past, but to do even better in the future; ensuring that LINNC seminars and courses provide the very best, offering open discussions and shared experience in the techniques, clinical knowledge and cutting edge technologies that make up our discipline of neuroradiology and neurosurgery today.
We also want to thank everyone who followed and participated by reacting to our live covering on Twitter.
See you at LINNC 2018 in Paris this June!