Come and join us across the globe
After a very nice evening beginning with a cocktail party on 5 level of our congress venue with its sweeping views of Marina Bay and the Singapore skyline, we were happy to be welcomed – and welcome you! – to the second day of this fabulous scientific course, designed to encourage audience and faculty interaction.
Cases submitted by our participants
We began the morning session with three cases submitted by the attendees themselves.
The first of these was by Dr Ayman Zakaria Mohamed (Qatar/Egypt) and showed a malformation from the skull base, allowing for an excellent anatomical review. This was followed by treatment of the observed fistula from the vertebral artery along with venous drainage, promising good long-term evolution for the patient. This allowed Profs. In Sup Choi and Jacques Moret to discuss the nature of dural fistulas, with pial venous drainage, looking at the techniques used as well as concerns involved in venous drainage.
The second case was presented by Dr Roopa I Seshadri, from India and concerned a case of hemorrhage with multiple aneurysms. This case provided the audience with an important review about wall imaging. After the presentation of this case, we discussed the interest and nature of wall imaging, as well as debating what is involved in its use. Wall imaging was seen to be not frequently used in the neuroradiological population.
The discussion then turned to carotid fistulas and indications for the treatment of balloon occlusions. Dr Shamick Biswas from India showed us new coils used to occlude cavernous carotid fistulas and inspired a debate between Prof. Jacques Moret and the audience about the use of detachable balloons. Prof. Moret said that there is no healing effect around a balloon – this effect does not exist – so it is difficult to argue for the use of this kind of device to directly treat fistulas.
BALT sponsored the first industry symposium of the day, which was presented by Prof. Jason Wenderoth and concerned improvements in flow diverters with the development of baby flow diverters for the treatment of distal aneurysms.
We then turned to the first recorded case coming from Bicêtre Hospital in France which involved an unruptured aneurysm. This case illustrated the use of virtual stenting on a 3D screen as well as the Sim & Cure technology which allows for the correct sizing of the stent.
A pre-recorded case involving a wake-up stroke was presented which involved a double-clot location: the brain plus the upper limb. The treatment chosen was the so-called “BADASS” technique with distal aspiration, an intervention of the proximal occlusion and the use of a stentriever for the carotid occlusion. By the fifth passage a TICI 2B result was achieved. Afterwards, the humeral artery was re-opened. Good evolution for the patient along with good recovery – as they say, “no pain, no gain”!!!
Prof. Laurent Pierot led the PHENOX industry symposium demonstrating the use of a p48 flow diverter stent with an interesting case of basilar artery aneurysm.
Prof. Jacques Moret presented a case involving the reconstruction of giant aneurysms using flow diversion. These provided for a good evolution, with good angiographic results at six months without it being necessary for the patient to take any antiplatelet medication.
For some of us, sometimes the mechanisms behind antiplatelet therapy are not clear, or remained poorly understood.
The radial approach was debated by the Bicêtre team with an interesting case involving the use of a flow diverter along with antiplatelet therapy. Prof. Laurent Spelle demonstrated the advantages of this technique which we try to use extensively in our department. The use of this arterial approach for cerebral angiography and therapeutic procedures allows us to reduce the patient’s hospital stay as well as the risk for retroperitoneal hematoma.
The first case of the afternoon was presented by Prof. Laurent Spelle and concerned the use of flow diverters in the treatment of pericallosal arteries. A good evolution was observed underlining the fact that the deployment of a flow diverter is a very good option to definitively treat aneurysms with less recanalisation than using coils alone.
Another interesting case was presented demonstrating the use of a Silk flow diverter stent in the treatment of recanalised aneurysms. The flow diverter was very easy to deliver, using the excellent “push and pull” technique.
The covered branch was not occluded.
We then turned to the venous approach in the treatment of small recurrent AVMs which was clearly described by Prof. Laurent Spelle. He spoke about the utility of detachable microcatheters in order to secure the injection.
Dr Abd Kadir from Malaysia presented a case of a partially thrombosed mid-basilar dissecting aneurysm.
Dr Noor UI Huda from Pakistan offered us a case of a hemangioma from the back scalp which was treated by a mix of onyx injection and a surgical approach.
A stroke case was presented by Dr Daniel Ng Wing Kit from Hong Kong.
The last case was a giant ruptured aneurysm from the communicant artery which bled and was first treated by coils. Three months later, after the acceptable recovery of the patient, we decided to do a new treatment due to a large recurrence. Two atlas stents were deployed in the two A2 segments because of the lack of lateral controls in the A1 segment. Coils were placed in the aneurysm sacs. The most difficult situation was to catheterize the A2 segment. This case demonstrated the Y-stenting technique with an exchange maneuver. Result at 6-month follow-up were perfect.
The final stroke case of the day was very rapidly performed with TICI 3 at first passage.
The key take-home message? Sometimes it's very easy, some times it's very difficult, but remember, we are saving lives!
Dr Roopa Seshadri from India received the award for best submitted case for her truly beautiful morning presentation concerning wall aneurysms enhancement.
Congrats from the entire LINNC team!
We would like to thank everyone for the warm welcome in Singapore!
We look forward to seeing you next year in Miami for LINNC Americas in March 2020 and in Paris for our flagship course - LINNC Paris in June 2020.
Be sure to join us for the special LINNC mix of challenging lives cases, exciting interactive discussions and the camaraderie that can only further enhance our already satisfying, wonderful medical activities.
Reported by :
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| Augustin Ozanne and Sophie Gallas | |
