Staying informed with the LINNC
Led by some of the leading experts in INR, the LINNC seminar allows us to learn everything we need to stay up-to-date and at the cutting-edge in this ever-changing field. Ongoing research in the field of interventional neuroradiology, improved techniques and available devices have dramatically increased these last few years leading to a substantial improvement in the treatment and outcome of patients affected with neurovascular diseases. The latest innovations and hot topics were all discussed in depth during the LINNC Seminar 2022 - Americas Edition.
An abundance of challenging and varied cases
To begin the second day, Dr. Eytan RAZ presented the first case on the management of an ophthalmic artery pseudoaneurysm in a one-eyed patient (which affected the other eye). This was an interesting and rare pathology that opened a discussion into the algorithm decision model in ophthalmic artery occlusion. A great case presentation that received the award by the faculty members of the best case submitted by attendees during the LINNC Seminar 2022 - Americas Edition in Miami.
The second case of the morning was an M1 dissecting aneurysm treated with a telescoping flow diversion stent technique by Dr. Sebastian JULIA. Sizing of an FD remains sometimes challenging and the follow-up angiogram showed that healing was not complete.
The recorded case series began with the treatment of a 100-year-old patient for stroke. This led to the intriguing discussion of what indications should be taken into consideration in choosing to treat these patients. Prof. Tudor JOVIN raised the very good point that if the indication is an acute myocardial infarct or ruptured aneurysm, the choice of whether or not to treat will not even be questioned.
The second recorded case demonstrated very well how the Sim&Cure simulation software can predict a good or bad outcome when using a WEB device in an AComA aneurysm with a daughter sac. The re-treating of this recanalization of a WEB device was accomplished using a stent assisted coiling technique (Lvis 3,5x18), another solution could have been an FD stent.
Dr Nicholas BORG presented the trans-venous embolization of a left T2 CSF-venous fistula via the lateral epidural space. This case underlined the importance of understanding the venous anatomy in order to archive a complete occlusion result.
The third recorded case focused on flow diversion in an anterior communicating artery aneurysm and the utility of Sim&Cure software in such cases.
The fourth recorded case of the day was a frontal AVM first embolized with Squid 18 LD and then followed by using Squid 12LD. This led to an interesting and passionate discussion around data from the of ARUBA Study, as well as a discussion on defining the concept of an angiographic cured AVM. Moreover, as our colleagues from North America suggested, a combined strategy of presurgical AVM embolization followed by neurosurgical removal of the AVM itself seemed to be a feasible solution.
The cases continue…the discussion too!
The afternoon began with a stroke case involving a difficult access which leading to the decision to make a direct carotid puncture. The modalities of the puncture and its closure were deeply discussed by our highly experienced and wonderful expert panel who concluded that, “you have to recognize when the access is difficult or even impossible by a femoral approach or by a radial or direct puncture, that it is necessary to change strategy and avoid any loss of precious time for the patient!”
The second case was an MCA aneurysm treated with Y-stenting with coil-assisted embolization. The debate centered around such concerns as the durability of stent and coils, the question of FD compared to clipping, or how the choice of the technique can be influenced by the age of the patient, with the question remaining about the final goal of aneurism recanalization in the light of bleeding risk.
We continued with a case of an aneurysm treated by what Prof. Jacques MORET calls “the kissing WEB” technique. The ensuing conversation was about the risk factors such as (re-)rupture of the aneurysm and especially the role of blood pressure control.
The last case was presented by Prof. Laurent SPELLE and concerned a siphon aneurysm treated with FD in a patient suffering from sickle cell disease and highlighted the key points involved in the management of these patients. Finally, an animated discussion by the faulty turned around the possible benefits of using robotics for better control of stent delivery.
The afternoon continued with a series of didactic cases which remain an important tool for continuing medical education and our ability to offer improvements in patient care.
First an interesting case presented by Dr Emanuele ORRU (USA) of a dural arteriovenous fistula treatment which resulted in a symptomatic sinus stenosis. Much discussion followed on the importance of understanding the symptoms and the rearrangement of flow after compartmentalized occlusion of the transverse sinus.
This case was followed by Dr Razmik BEBEDJIAN (Canada) who presented a case of a distal PCA aneurysm that took an unexpected turn. Be prepared is the key.
Later, Dr Jeremy PETERSON (USA) presented a case of a basilar tip aneurysm that emphasized the downstream vascular changes after flow diversion.
Dr Carlos PEREZ-VEGA (USA) demonstrated the new hybrid TCAR procedure on a case of cervical carotid stenosis.
Finally, we ended the afternoon with the award for the best submitted case to Dr Eytan RAZ which we spoke about above.
A fine way to complete an excellent two days of learning, discussions and camaraderie.
Soon in Paris!
We really want to thank everyone who attended as well as those who participated by reacting in live stream. We are truly honored by all the positive feedback we received from participants, and look forward to welcoming you all in Paris this upcoming June for what promises to be an unforgettable LINNC Paris Course 2022 .
See you there!
Report by Dr Vanessa CHALUMEAU & Dr Cristian MIHALEA
