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LINNC China 2025 – Day 2 Highlights: Tailored aneurysm management, staged intervention and long-term follow-up
The second day of the LINNC Seminar began with two complex case presentations, setting the stage for the opening ceremony, which brought together leaders and pioneers in the field of interventional neuroradiology. The session emphasized the latest advances in individualized aneurysm management, highlighting staged interventions, innovative devices, and the integration of advanced imaging to optimize patient outcomes.
The first case focused on a fourth endovascular treatment of a non-ruptured ACOM aneurysm with a challenging neck located at the A1-2 segment on the right. Snuffbox radial access was employed, demonstrating stepwise catheter navigation, including the careful management of the tip against the aneurysm wall. Postoperative follow-up included Xper CT imaging and deployment of a Pipeline Vantage 2.5 x 14 mm device. At six months, a small aneurysm remnant was observed, leading to the discontinuation of Ticagrelor while continuing aspirin. Subsequent follow-ups at 1.5 and 3.5 years showed a stable but persistent remnant. Discussion among the faculty considered whether additional coiling was warranted, with opinions varying based on circulation within the aneurysm, perforator presence, and the reconstructed arterial anatomy. The consensus leaned toward conservative management, with careful monitoring, acknowledging that the residual risk was significantly reduced.
The second case presented a 29-year-old male with multiple posterior circulation aneurysms, including a giant partially thrombosed basilar artery aneurysm causing mass effect, hemiparesthesia, and vertigo. Initial management involved observation and thrombus modification, but the emergence of new symptoms necessitated treatment.
A staged approach was applied: first, a posterior fossa craniectomy, followed two months later by endovascular treatment. The procedure involved a complex scaffolding strategy using a Leo braided stent and subsequent deployment of multiple Silk Vista Flow Diverters to slow flow and organize the clot within the aneurysm. Additional coil embolization was performed to optimize sac occlusion. The patient experienced acute postoperative cerebellar edema and neurological deficits, managed with steroids and antiplatelet adjustments. Over a follow-up period extending to 2.5 years, the clot progressively decreased, neurological function normalized, and the basilar trunk remained patent, illustrating the effectiveness of careful staged intervention for complex thrombosed aneurysms.
Additional cases highlighted evolving techniques and device strategies. Vitor Mendes Pereira presented the increasing use of Tetra coils, particularly for small and complex aneurysms, emphasizing the importance of device design in stabilizing the aneurysm sac and reducing procedural risks.
Examples included small ruptured ACOM aneurysms, distal PICA aneurysms, and unruptured MCA aneurysms, demonstrating nuanced catheter navigation, balloon stabilization, and layered deployment strategies to minimize complications. Nan Lv from Chang Hai Hospital also showcased Tetra coils for tiny aneurysms, demonstrating versatility across multiple challenging cases.
Yongjie Ma presented the use of Pipeline Shield embolization devices for both absolute and relative indications, including large incidental aneurysms and complex distal lesions. Discussions focused on device sizing, antiplatelet strategies, and the role of OCT in assessing stent apposition, especially in patients with multiple overlapping flow diverters or fusiform aneurysms with numerous perforators. The importance of balancing sufficient coverage with procedural safety and minimizing ischemic risk was emphasized across these cases.
Throughout the session, faculty repeatedly stressed the principles of individualized treatment, staged interventions, and meticulous planning. The discussions highlighted a range of technical nuances from radial access strategies and balloon-assisted stabilization to the sequential deployment of stents and flow diverters, with careful attention to hemodynamics and perforator preservation.
Collectively, the day’s cases demonstrated not only the technical sophistication of contemporary neurointerventional therapy but also the importance of collaboration, peer discussion, and long-term follow-up in achieving optimal patient outcomes.
Reported by Eileen Liu
