Stroke or ischemic disease, aneurysms or AVMs – LINNC Americas, where cutting edge technologies meets clinical experience!

The second day of LINNC AMERICAS 2023 has been as exciting as the first!

The four cases selected from those submitted by attendees today dealt with ischemic disease.

Dr Harris Kamal from Miami, USA presented a case of double rescue stenting for a refractory left M2 occlusion in a young patient: the first, with a classical laser-cut stent, was not efficient and the second, with an occlusion balloon-mounted drug eluting stent, managed to open the vessel. This was followed by two cases presented by Dr German Caballero from Argentina. The first case concerned a basilar artery occlusion secondary to a tight stenosis in the right vertebral artery. The Argentinian team chose not to stent this in the acute phase, but the patient had an early relapse stroke. Dr Caballero then showed a case involving the treatment of a contralateral stroke by mechanical thrombectomy and IV thrombolysis where the treatment was complicated by an intraparenchymal hematoma where the patient had undergone neurosurgery 20 years before. Finally, Dr Rafael De Oliviera Sillero from the USA presented a pediatric stroke case where the patient underwent mechanical thrombectomy.

Stroke and ischemic disease were also the topic of several of today’s recorded cases.

Prof. Laurent Spelle presented a case of a sub-occlusive stenosis of the carotid sinus with a huge floating clot in the cervical carotid. Since this situation is highly unstable, with the risk of distal clot migration, the patient underwent ICA angioplasty and stenting, but distal clot migration occurred into the M1 segment of the MCA which was successfully recanalized by a single pass thrombectomy with a stent retriever. This case gave rise to a discussion on whether or not we should use distal protection devices in such cases.

The two other recorded stroke cases were of a successful mechanical recanalization of a distal (M3) MCA stroke with a single pass thrombectomy; and a very nice example of the so-called “BADASS technique”, a combination of stent retriever thrombectomy, distal aspiration and ICA flow reversion with a balloon-guided catheter, where the goal was to optimize the first pass effect in the successful treatment of an M1 occlusion.

Prof. Vitor Mendes Pereira presented the first recorded aneurysm case of the day, a giant fusiform aneurysm of the M1 segment of the MCA in a pediatric patient. This was treated by parent artery reconstruction using flow diverters placed in a telescopic manner and consecutive partial coiling of the aneurysm sac through a jailed microcatheter. As discussed during Day 1 of the seminar, this case illustrated the use of OCT and gave Prof. Mendes Pereira the occasion to demonstrate the major contribution of OCT to the understanding and monitoring of stent placement and guidance in intrastent balloon angioplasty.

Then Prof. Laurent Spelle presented a recorded case of a very tricky acutely ruptured ACom aneurysm that was treated by bilateral flow diverter reconstruction of the anterior cerebral artery in order to hemodynamically exclude the ACom. Nevertheless, the vessel anatomy made the sizing and stent placement very difficult and, on the right side, a first malpositioned flow diverter had to be extracted with a lasso because it protruded into the terminal carotid artery. 

Additionally, Prof. Spelle presented as part of the second day’s recorded cases, two cases of bifurcation aneurysms which were treated by intrasaccular flow diversion devices, one of them placed with the help of a micro-balloon. This allowed Prof. Spelle to explain how the balloon is employed to provide a constraint to the WEB device and he pointed out how the balloon must be inflated before the placement of the WEB. Nevertheless, balloon inflation cannot be used as a bailout solution for a malpositioned detached WEB and, in these cases, placement of a stent is mandatory.

Prof. Spelle also presented two other tricky aneurysm cases. The first involved flow diverter treatment of an ICA siphon aneurysm complicated by delayed vasospasm in the downstream vessels; the second was a case of Y-stenting with braided stents and coiling for a wide-neck MCA bifurcation aneurysm.

Prof. Jacques Moret presented two recorded cases of transvenous AVM embolization: the first, a small parietal AVM and the second, an AVM of the tectal plate.

This was followed by Prof. Spelle who showed us a recorded case of a presurgical embolization of an endolymphatic sac tumor by direct puncture; explaining to us as he presented the case how to use the XPerGuide tool to obtain perfect needle placement before injecting the glue.

Dr Santochi Tateshima from California, USA presented his first experience with newly shaped coils – the so-called tetrahedron shape coil –which are supposed to increase shape memory and intra-aneurysmal anchoring of the coil.

Dr Ricardo Hanel from the USA presented the Colossus guidewire, a 0.045’’ guidewire with the same structure as the Aristotle wire he had demonstrated the previous day. Dr Hanel has specifically used the Colossus wire in patients with stroke in order to track the aspiration catheter directly to the intracranial occlusion.   

The first industry sponsored symposium, led by Dr Reade De Leacy from the USA, also dealt with the Aristotle guidewires