We’re finally back in truly amazing Singapore, at the National Gallery for LINNC Seminar 2022 Asia Edition, DAY 1: sharing wonderful cases and dreadful complications…
The first case was a challenging one concerning a mycotic aneurysm of the right MCA presented by the attendee, Dr Youngjin Kim from Seoul, Republic of Korea. The patient was treated with a parent artery occlusion using coils and glue.
The first recorded case presented in “live” conditions was introduced by Prof. Laurent Spelle. It was a recanalized anterior communicating artery aneurysm that had previously ruptured 13 years before. The discussion was focussed on the indication and exploring the multiple management possibilities: stent + coils, intrasaccular devices, flow diverters or clipping… You decide! In this specific case, the recurrence was managed using a flow diverter deployed on the A2-A1 dominant side. This strategy led to a heated debate on flow diverters covering collateral branches!
The second recorded case was of a dural AVF of the cavernous sinus with a twist. Prof. Jacques Moret showed us a technique of inferior petrosal sinus catheterization! Again, in this case, several treatment options were possible leading to an interesting discussion involving the expert panel and attendees.
The morning continued with the same enthusiasm with 3 more challenging recorded cases in performed in “live” conditions. These included the treatment of a T-carotid aneurysm treated, a ruptured MCA aneurysm with multiples micro-aneurysms and a M1 thrombectomy. Professors Moret and Spelle, with delightful wit, presented their strategies to the audience: intrasaccular flow disruptive devices, coils and flow diverters for the aneurysms, aspiration catheters or stent retrievers for the thrombectomies – all of which led to a new round table with high quality and enriching discussions.
To conclude the morning session, Prof. Dae Chul Suh from Seoul, Republic of Korea, presented a tricky spinal osseous AVM including pial AVF. What to do? If possible to treat, how?
In the afternoon, Prof. Spelle surprised the attendees with a particularly difficult ACom dysplatic aneurysm. All options were on the table and all were discussed. Then we continued with the topic of AVMs with surprising case of a recurrent parietal micro-AVM treated through venous access. As always, this topic brought about a passionate debate on AVM access for embolization. Then the seminar continued with a very straightforward case of a carotid aneurysm treated using a flow diverter; nonetheless, poor apposition of the flow diverter led to a difficult situation to manage!
Talking about flow-diverter Dr Alejandro Tomasello from Barcelona, Spain, who granted us the first results using a novel flow diverter based on microporous membrane technology, very promising!
The day ended with a session from the dark side of INR…!
Professors Moret & Spelle, along with some of the attendees, shared several cases that had turned into nightmares because of dramatic complications.
How can we manage – or more importantly – how can we prevent these situation?
Ethical questions were raised as well.
A difficult topic, but it is important that we face our past mistakes in order to advance.
Challenging cases and passionate discussions between the expert panel and the attendees made the 1st day of the LINNC Seminar 2022 – Asia edition an excellent and captivating moment!
It is now time for a well-deserved cocktail on the roof of the Singapore National Gallery, enjoying the nice weather and the scenery with friends and colleagues.
Cheers…and see you tomorrow for the second day!
Jonathan Cortese & Jildaz Caroff