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Good morning, Bangkok!
We kicked off our first session with a condylar vein dural fistula from Dr. Pulappadi. He presented a case of a condylar vein dural arteriovenous fistula treated through the venous route.
Back to recorded cases, Prof. Spelle presented a case of a middle cerebral artery aneurysm. Prior to flow diversion, he performed a balloon occlusion test to demonstrate which M2 had collateral supply from the anterior cerebral artery and posterior cerebral artery.
Upon confirming good collateral supply in both M2s, he placed the flow diverter in the branch supplying the motor strip.
The next case was from Prof. Moret (Neuri Bicêtre). He presented a case of an anterior communicating artery aneurysm treated with an intrasaccular flow disruptor. He emphasized the importance of obtaining the optimal position before deploying a Contour device.
Dr. Teelala from India presented his case of a flow diverter with clot formation after deployment. This was treated with another aspiration thrombectomy and intracranial stenting.
We moved back to recorded cases with Prof. Spelle showing a double internal carotid artery aneurysm case. Prof. Pereira discussed how two aneurysms very close together likely represent the same pathologic process. A flow diverter was placed and this obliterated both aneurysms. A lively discussion of flow diverter placement ensued, moderated by Prof. Pereira.
For the last case prior to the morning coffee break, Prof Spelle showed a case of an anterior communicating artery aneurysm treated with balloon-assisted coiling. Following one of the themes of the conference—coiling with balloon assistance still very much maintains its place in aneurysm treatment, especially in ruptured cases.
After the break, we had our first industry-sponsored talk from Medtronic by Dr. Vipul Gupta from India. He discussed his experience with the Pipeline Vantage, showing multiple aneurysm cases treated with the flow diverter. He demonstrated how the device can work on its own or as an adjunct to coils. Even in cases where significant intimal hyperplasia appeared to cause stenosis, the patients remained asymptomatic.
We followed up with a stroke case from Neuri Bicêtre presented by Prof. Moret. The case was a 1 pass TICI 3 right M1 occlusion. What followed was a lively discussion on the different techniques that may be used for stroke thrombectomies. The next case was an arteriovenous malformation from the same centre. A delayed repeat angiogram revealed an arteriovenous malformation
in the posterior fossa. This was treated with an elegant transvenous embolization of the AVM.
Before lunch, we had another industry-sponsored talk, this time from Balt, delivered by Dr. Gavrilovic. He relayed his experience with the device and emphasized the advantage of Silk flow diverters which can be delivered through smaller microcatheters. The Silk Vista Baby devices in particular can be deployed through a 0.017 microcatheter and the bigger-sized ones through a 0.021.
Coming back from our phenomenal lunch, Prof. Spelle opened the afternoon session with a ruptured anterior communicating artery aneurysm. He opted for intrasaccular flow disruption. For this case, he emphasized the importance of sealing the base of the aneurysm with the intrasaccular device, and utilized several views to ensure this.
The next case was that of an intracerebral hematoma with an apparent early filling vein suggestive of a malformation. A micro-AVM was found and treated with a liquid embolic. Prof. Moret emphasized the importance of detecting early draining veins in angiograms as they likely herald shunting lesions despite the absence of a clear nidus.
We went back to the best cases submitted by attendees. Dr. Choudhri from the USA presented a dural fistula elegantly treated with coils in the draining vein. Dr. Sagai from Japan presented flow diversion for multiple aneurysms in the right middle cerebral artery and right internal carotid artery. Dr. Diestro followed up with a challenging case of a recurrent basilar artery aneurysm treated with a neck bridging device and coils.
Prof. Vitor Pereira presented the protocol for pulsatile tinnitus at St. Michael’s Hospital. He showed the procedure of venous sinus stenting and emphasized that a pressure gradient is not necessarily present in pulsatile tinnitus patients in contrast to idiopathic intracranial hypertension patients.
Congratulations to Dr. Liaqat from Pakistan for winning the best poster presentation and Dr. Sugai from Japan for the best oral presentation. Dr. Liaqat has won a trip to LINNC Asia 2025 in Vietnam while Dr. Sugai has won a trip to LINNC Paris!
Prof. Spelle presented another case from Bicêtre of a difficult flow diversion of an unruptured middle cerebral artery aneurysm. It was particularly challenging on account of an unanticipated foreshortening of the flow diverter. All’s well that ends well!
That concludes LINNC Asia 2024, a fantastic conference with dynamic attendees and speakers!
Reported by Jose Danilo B Diestro