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The conference started off with a warm welcome from Profs. Jacques Moret, Laurent Spelle, and Vitor Pereira, and Local Course Director Dr. Thaweesak Aurboonyawat.
The first segment of the program was for the best cases submitted by the attendees. Dr. Iroda Mammadinova, a young neurosurgeon from Kazakhstan, presented a case of kissing flow diverters. After two flow diverters were placed, follow-up imaging showed complete obliteration of the aneurysm. This was followed by a case from Dr. Wan Mohammad Ibrahim Wan Azman, who shared an interesting case of dAVF presenting with cognitive impairment.
After the first two cases were presented, the rest of the course faculty introduced themselves. Prof. Spelle then showed a case of a wide-necked MCA aneurysm as the first recorded case of the conference from Neuri Bicêtre. He underlined that the vast majority of BOSS 1 WEB occlusions usually improve over time to complete occlusion (40%).
Moving on to the second morning session: Prof. Spelle presented a case of a dissecting aneurysm of the vertebral artery associated with vessel stenosis. With careful flow diversion, the neck of the aneurysm was fully covered, and follow-up imaging showed aneurysm obliteration.
Prof. Mendes Pereira presented the first case from St. Michael’s Hospital. After stent placement, OCT was used to evaluate the inside of the stent. This helped plan retreatment with angioplasty and the placement of a second flow diverter.
After the first two cases were presented, the rest of the course faculty introduced themselves. Prof. Spelle then showed a case of a wide-necked MCA aneurysm as the first recorded case of the conference from Neuri Bicêtre.
He underlined that the vast majority of BOSS 1 WEB occlusions usually improve over time to complete occlusion (40%).
Moving on to the second morning session: Prof. Spelle presented a case of a dissecting aneurysm of the vertebral artery associated with vessel stenosis. With careful flow diversion, the neck of the aneurysm was fully covered, and follow-up imaging showed aneurysm obliteration.
Prof. Mendes Pereira presented the first case from St. Michael’s Hospital. After stent placement, OCT was used to evaluate the inside of the stent. This helped plan retreatment with angioplasty and the placement of a second flow diverter.
We moved on to an industry sponsored case discussion from Terumo Neuro. Dr. De Villiers from Australia spoke about her experience with the flow diverter, FRED X. We reviewed the properties that make this flow diverter unique, specifically the surface modification that reduces thrombogenicity while maintaining the natural vessel healing response.
Dr. Kim from Korea discussed his experience with the WEB device. He pointed out the importance of sizing in the use of the device for intracranial aneurysms. He featured cases where he utilized adjunct devices such as balloons and intracranial stents as well.
Back to LINNC cases! The next case was presented by one of the attendees, Dr. Bhatia: a hypoglossal canal dural arteriovenous fistula treated with both coils and liquid embolic through the venous system. This was followed by Dr. Teoh from Australia presenting a case of an ethmoidal dural arteriovenous fistula. With the use of a distally placed DMSO-compatible balloon through the middle meningeal artery, he was able to embolize the fistula completely.
Going back to our recorded cases, Prof. Moret presented a double aneurysm case from Bicêtre. Returning to basics, they used balloon-assisted coiling for both aneurysms and obtained optimal results! Unfortunately, this complex case was complicated by symptomatic vasospasm that led to intraprocedural rupture during balloon angioplasty.
The last talk before lunch was again from Dr. De Villiers. She talked about the Philips Azurion machine and its many features that allow optimal imaging for complex aneurysm cases. The software allows for easy treatment planning and intraprocedural guidance.
After a fantastic lunch, we went back to recorded cases with Prof. Moret. The patient from Bicêtre, had a dural fistula with challenging access. He demonstrated that access is possible even if the inferior petrosal sinus is not visible on arterial runs.
For the day’s third industry sponsored symposium Dr. Park talked about his experience with the Stryker Target Tetra coils. He discussed how the tetrahedral shape allows for a more stable configuration inside the aneurysm. This is especially useful for smaller aneurysms with wide necks that can only take 1-2 coils.
Moving on to another recorded case from Bicêtre care of Prof. Spelle. The case was an occlusion of a left distal M2 branch, recanalized with a small stent retriever. A very elegant pull of a small clot that helped resolve aphasia. Prof. Moret followed up with an anterior communicating artery aneurysm treated with another intra-saccular flow disruptor, Artisse. He discussed the differences with the more well-known WEB device.
After the break, we move on to the most interesting part of all LINNC conferences: the Dark Side of INR. First up was Dr. Aurboonyawat presenting endovascular treatment of a Borden 1 fistula complicated by cortical venous occlusion. He drew attention to the importance of the tentorial sinuses and the role of patient positioning for visualizing these during delicate fistula embolization. These sinuses are better viewed with more exaggerated Towne’s or Water’s views. Next up, Dr. De Villiers presented an anterior communicating artery aneurysm treated with an intrasaccular flow disruptor. She insisted that there is a need for solid clinical data to back up the effectiveness claims for all new devices. Furthermore, coiling is an older but still an effective treatment modality for intracranial aneurysms.
That concluded the first day of LINNC Asia 2024. We leave you today with this photo of the Course Directors and Local Faculty. Stay tuned for the report on Day 2.
Reported by Jose Danilo B Diestro