A full morning
The first day began with a case of osteodural arteriovenous fistula of the cavernous sinus with cortical reflux presented by Eef HENDRIKS from Canada. The strategy presented was the occlusion with coils of the venous output which inspired a challenging discussion about whether to use or not use embolic liquid in this type of indirect FCC.
The first recorded case was presented by Prof. Laurent SPELLE raising the question of whether the treatment of a recanalized AComA aneurysm with only one contralateral (A1-A2) flow diverter (Fred Jr) would be enough to heal the aneurism. Multiple solutions, including neurosurgical clipping or Contur devices were discussed as potential options.
The challenges of using FD in bifurcations (MCA, AComA complex) is still a hot topic in the neuroradiology field with pro and con arguments and also the need for a large series of clinical studies.
The third case was presented by Hilario Paul ALANIS RESENDIZ from Mexico. This concerned a dural arteriovenous fistula treated with 1 ml of PHILL and emphasized the importance of understanding the anatomy and the follow-up angiograms as the key parts of a successful treatment.
The fourth case of the day – a frontal AVM – was recorded in CHU Bicêtre Hospital, NEURI department, France and presented by Prof. Jacques MORET illustrating the competition between an arterial and venous approach. The arterial approach and the use of Onyx 18 were the chosen strategy to cure the AVM, even though a venous approach had initially been prepared. Recurrence of a treated AVM is an infinite field of debate that came to light during the discussion that followed.
The day continued with a recorded case of a thrombectomy of the M2 segment treated with an ERIC device.
The sixth case of this morning highlighted the utility of a re-tubing technique in those cases where a shortening of a flow diverter is observed just after deployment. A very interesting and captivating discussion followed concerned the potential thromboembolic complication due to the coverage of the anterior choroidal artery.
The day continued with a recorded case of an osteodural AVF of the cavernous sinus with thrombosis of the superior vena cava and inferior petrosal sinus treated using a microcatheterization technique. Onyx injection through this venous pathway led to complete healing of the AVF. The pros and cons of whether to embolize the cavernous sinus using embolic liquid versus coiling engendered a challenging debate among the experts and participants.
The eighth case, recorded by Bicetre NEURI team, presented the elegance of the WEB device in conjunction with Sim and Cure simulation software in a flat AComA aneurysm. The technique of WEB deployment was also well illustrated during this case with the critical “tips and tricks” that have to be mastered during manipulation of this intrasaccular device.
Challenging discussions
The recorded case session continued with a stroke case using 8 mg of i.a. thrombolysis after stent retriever thrombectomy. This situation kicked-off an intense discussion among faculty members concerning the CHOISE study and its practical limitations. The question of how an adjuvant treatment could become part of a daily practice routine in select cases remains unresolved.
Another recorded case, drug-eluting stent placement in basilar artery, was presented by Dr. Christian Ferreira. Several interesting questions came up about using DES cardiology stents in acute atherosclerotic lesions with the dilemma of whether to treat or not to treat – and even the indications for such cases – remaining a challenge in our daily practice.
The ninth recorded case presented an elegant and simple treatment using a Silk Vista Baby flow diverter to recanalize a distal pericallosal aneurysm. At the present time, this is the only FD currently available for specialists that can be delivered through an 0,017 catheter – a characteristic that inspired another round table discussion on the treatment of distal bifurcation aneurysms with flow diverter stents.
The last case of the day was the treatment of an acute M1 occlusion in a 93-year-old patient using the new Vecta 74 aspirating catheter. The technical advance offered by using a large bore aspirating catheter is a huge step forward in achieving TICI 3 after a first passage thrombectomy.
The day ended with a session on the dark side of INR where Jacques Moret, Laurent Spelle and two case authors presented the most complex cases whose complications and how we address them form the basis of our learning experience.
Challenging cases and passionate discussions, all led by experts from our faculty panel made for an excellent and captivating Day 1 of LINNC Seminar 2022 - Americas Edition with 8 hours streamed worldwide for those who couldn’t be with us in person!
Report by Dr Cristian MIHALEA & Dr Vanessa CHALUMEAU
