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Day 1 at LINNC China 2025 — Live from Shangai!
For the first time, LINNC China joined forces with the Shanghai Neurointervention Forum (SNF) and the Annual Meeting of the Neurointervention Committee of the Shanghai Medical Doctor Association to deliver three exceptional days of education, discussion, and innovation in neurointerventional medicine.
The opening day featured a dynamic series of complex case presentations and discussions led by Jacques Moret, Laurent Spelle, Vitor Mendes Pereira, Hongqi Zhang, Liu Jianmin, and Li Qiang, highlighting the precision, adaptability, and evolving strategies that define the modern neurointerventional landscape.
The day began with a technically demanding case presented by Vitor Mendes Pereira involving a 64-year-old patient with a recurrent left ICA terminal aneurysm, previously treated with multiple coilings. Given the aneurysm’s wide neck and short MCA branch arising from the sac, a Surpass Evolve 5×17 flow diverter was selected. Deployment was achieved using an XT27 microcatheter and dual-wire technique to mitigate the ledge effect.
Panelists emphasized the importance of reducing the microcatheter–wire gap to navigate through previously coiled sacs and discussed unsheathing over pushing techniques to optimize stent opening.
In the discussion, faculty debated the role of angioplasty for stent apposition, duration of dual antiplatelet therapy, and treatment sequencing for recurrent aneurysms, contrasting intrasaccular devices with flow diversion in bifurcation anatomy. Jacques Moret underlined that apposition remains the key determinant of long-term FD efficacy.
The following presentation by Laurent Spelle featured a 16-year-old male with a ruptured caudate AVM following a jet ski accident. The lesion, supplied by the Hubner artery with limited venous drainage, was managed by transarterial Onyx embolization. Despite intra-procedural rupture, complete occlusion was achieved without neurological deficit. Discussion focused on Onyx concentration selection, DMSO dilution techniques, and reflux control in narrow-caliber arteries.
Faculty debated whether a transvenous route or glue embolic might have offered lower risk, but agreed that Hubner artery occlusion–related hemiplegia is rare. Vitor Mendes Pereira emphasized case-based risk modeling and referenced ARUBA trial implications for AVM management. The consensus: effective embolization depends not only on material choice but also on anatomical understanding and procedural restraint.
Next, Jacques Moret presented a 35-year-old woman with a ruptured dissecting PCA aneurysm (P2–P3 segment), treated with a FRED Jr flow diverter to reconstruct the parent artery. Pre-treatment involved ASA and ticagrelor, and careful navigation was required through the stenotic, dissected vessel. VasoCT confirmed optimal wall apposition and complete aneurysm exclusion at follow-up.
The discussion centered on coil use in acute dissections, the impact of DAPT in the presence of hematoma, and follow-up imaging protocols. Faculty agreed that device selection should align with vessel geometry rather than brand preference, with braided stents favored for their predictable flow-diverting properties.
Attention then turned to a case presented by Vitor Mendes Pereira of a 91-year-old female with a Left M2 occlusion and prior atrial fibrillation on apixaban. Mechanical thrombectomy was performed using a stent retriever and balloon-guided aspiration, achieving full recanalization after two passes and complete neurological recovery. The case demonstrated the importance of system stability, device timing, and clean aspiration technique. Panel discussion compared proximal versus high cervical balloon positioning, with experts warning that overly distal balloon inflation increases the risk of dissection, while proximal placement ensures control without sacrificing efficiency.
Laurent Spelle then presented a 30-year-old woman with an incidental right ICA bifurcation aneurysm managed using a WEB intrasaccular device. Despite minor protrusion, long-term follow-up demonstrated stable occlusion up to 6.5 years. Discussion centered on WEB sizing strategies, management of protrusion, and comparison with Contour.
The panel concurred that oversizing enhances occlusion durability, and that WEB “recurrence” represents anatomical remodeling rather than true failure, distinguishing it from coil compaction.
A subsequent case involved a 47-year-old male with SAH and a recurrent bifurcation aneurysm. A balloon test occlusion guided the decision to place a flow diverter in the inferior branch, preserving flow while excluding the aneurysm. The patient recovered fully after transient ischemic symptoms likely linked to DAPT and cannabis use. Faculty praised balloon test occlusion as a valuable planning tool for complex bifurcations and discussed Y-stenting as an alternative strategy when FD coverage is insufficient.
Jacques Moret then showcased a 66-year-old woman case with a vermis AVM and cerebellar hematoma, treated via transvenous Onyx embolization. The team alternated arterial and venous approaches to access the small nidus, achieving complete obliteration at 1.5 years.
Hongqi Zhang ended the session with a 75-year-old man with a right cerebellar dural fistula, successfully treated with balloon-assisted Onyx injection using an Eclipse balloon. Both cases underscored the value of precise microcatheter control, plug formation, and gradual Onyx injection to ensure durable closure and minimize reflux.
Reported by Eileen Liu
