Come and join us across the globe
We are here in Beijing for the first day of the LINNC China 2024 Seminar. This is the first time with on-site attendees since the Covid pandemics, sharing wonderful cases and pitfalls among friends.
The LINNC Seminar 2024—China Edition began with a warm welcome from the seminar directors, Hongqi Zhang, Jianmin Liu, Jacques Moret, Laurent Spelle, and Vitor Mendes Pereira.
The day’s first session began with Doctor Ming Ye presenting a case of bilateral MCA aneurysms, one of them ruptured and clipped, the other contralateral one coiled in a second procedure. This was followed by Yongje Ma’s presentation of a duro-arachnoïdal DAVF of the Vena Galeni which was treated by transarterial embolization, first with
polymerizing liquid embolus through pial feeders reducing the flow in the fistula, followed by its complete embolization EVOH through MMA. This case highlighted the importance of understanding DAVF’s anatomy to plan the treatment.
After that, Wang Yang presented a case of moya-moya disease with an aneurysm of the homolateral ICA siphon, which was treated by angioplasty and stenting of the stenosed MCA, and Chuan He showed the treatment of a recurrence of an MCA bifurcation aneurysm after embolization with an intrasaccular device. The treatment was performed with stent-assisted coiling and gave birth to a lively discussion on whether or not complementary treatment should be performed immediately after an early control or if the aneurysm should be surveyed since spontaneous occlusion can be observed in some cases and other treatment options were discussed including a flow diverter.
After a short industry-sponsored symposium by Achieva about chronic carotid artery occlusion recanalization with the intracranial protection with a stent retriever, Laurent Spelle presented the day’s first recorded case in “live conditions" which featured an irregular ruptured ACOM aneurysm treated by balloon remodelling, preserving the patency of the ACOM itself.
This case demonstrated the importance of adapting the initial strategy to the anatomical reality and being ready to change the approach and the material itself. When choosing a microcatheter, its flexibility versus its stability must be considered. The consecutive discussion focused on whether the ACOM should be kept patent using a more complicated and potentially more risky strategy or not.
After that, Professors Yongjie Yuan and Sheng Guan, Chuan He and Yang Wang, exchanged during a round-table discussion on their respective experiences on flow diverter treatment of distal aneurysms. They agreed on the necessity to have low profile material like the new generation flow diverters going through a 17 microcatheter.
Then Jiaxin Huang showed a dissecting PCA aneurysm managed with coil-assisted stenting.
For the 2nd recorded case, Laurent Spelle presented a treatment of two unruptured homolateral MCA aneurysms with the so-called "WEB remodelling technique" in which the balloon is used to constrain the WEB and adapt its direction during deployment. He showed an example of this technique in another recorded case during the afternoon session.
We moved through the day with the next recorded case presented by Jacques Moret of a ruptured parietal AVM treated by trans arterial embolization with EVOH, and he pointed out the importance of filling the foot of the vein as the ultimate goal of the treatment to ensure permanent cure.
Next, we focused on stroke and Laurent Spelle presented a recorded case of a recanalization of a left MCA occlusion in a centennial patient with the so-called BADASS technique, combining a flow inversion with a balloon guiding catheter, a distal aspiration and a stent retriever thrombectomy, in order to optimize the first-pass effect.
We continued with another challenging recorded aneurysm treatment: a recurrent ACOM aneurysm initially treated with an intrasaccular device. The recurrence was treated with coil remodelling giving a certain flexibility followed by a braided stent placement in order to stabilize the coils on a long-term basis and help the aneurysm heal. This led to another interesting debate with the audience on the first-place strategy and the retrieval after a treatment failure.
After the sponsored Terumo Neuro symposium about the Chinese experience with the WEB device and the FRED flow diverter, Guoli Duan, Yongjie Yuan and Lei Zhang, from Shanghai, presented three very challenging cases: A very elegant treatment of a brain AVM with a variant of the pressure – cooker technique, a very tricky recurring fusiform PCOM aneurysm in a patient having a homolateral ICA occlusion, and an aneurysm treatment in a patient with symptomatic ICAD.
Once again, the day was enriched with select cases from our attendees: Microstroke after treatment of an unruptured ACOM aneurysm with a WEB by Lixin Huang, and treatment of a complex basilar tip aneurysm in a patient with bilateral moya-moya disease with parallel placement of two stents and consecutive coiling by Zhiqiang Yao, which led to high-quality roundtable discussions.
After another sponsored symposium by J &J CERENOVUS MedTech on the Choydar flow diverting stent, the day ended with a session on the dark side of INR! Jacques Moret shared a case of a duro-arachnoid AVF of the falcotentorial junction in which a series of mistakes led to a dramatic complication. A very difficult topic, but it is important that we face our past mistakes to learn to prevent future ones and advance.
We are looking forward to the second day of the LINNC China 2024 with new instructive cases and constructive discussions.
Reported by Léon Ikka and Eileen Liu
