LIVE CASES TRANSMISSION
June 11, 2018 - 17:15-18:00
In treating an aneurysm, have you ever tilted a WEB device? How does a balloon help? Would you rather clip or coil instead? Join Profs. Jacques Moret and Laurent Spelle, for this live case from the 2018 edition of LINNC Paris and discover how tilting – and a balloon, make final positioning in the aneurysm sac possible…. Watch now!
A 56-year-old man with high blood pressure and heart failure, who suffered an earlier left thalamic lacunar stroke, is treated for a right MCA aneurysm in this live case presented during the 2018 edition of LINNC Paris. Join Prof. Jacques Moret (Neuri Center, Paris), Igor Pagiola (Brazil) and Vanessa Chalumeau (Paris) as they use the Woven EndoBridge (WEB) Aneurysm Embolization System, employing a balloon-assisted technique to aid in the final positioning of the device. With commentary by an expert panel led by Prof. Laurent Spelle, follow as the case unfolds from the initial sizing of the aneurysm, to the placement of the WEB, to a discussion of best treatment choices available today. We see the use of tools such as the Philips Azurion system, with an interface allowing for ease of access to a vast range of data and visualizations as well as the integration of external sources such as the Sim & Cure simulation program, used here to plan the intervention and determine the ideal size of the device.
In this particular case, the angulation between the M1 and the neck of the aneurysm complicates aligning the WEB correctly within the aneurysm sac. This necessitates precisely tilting the WEB within the sac of the aneurysm, something we see which requires the constraint provided by a balloon catheter. With a step-by-step commentary by Laurent Spelle, Prof. Moret illustrates this balloon-assisted placement – similar to a remodeling technique – from the precise manipulation of the various devices, to the placement of the WEB by pulling and pushing on the system to tilt the device in order to align the base of the WEB with the bifurcation – an angulation “that you could not open” without the constraint of the balloon.
The WEB correctly in place, the discussion begins with the audience and expert panel. Should this aneurysm be “clipped” or is the WEB the good choice? What about coils? In general, what are the possible advantages of clipping over an endovascular solution? Does one procedure compress the sac, while the other expands it?
What are the current safety data concerning any of these choices? Can a WEB be used in ruptured aneurysms? And, if so, how long does it take for an acutely ruptured aneurysm to thrombose after WEB us?
These LIVE cases correspond to the highest ethical standards in medicine and are posted on LINNC Online for educational purposes only to allow medical professionals to improve their knowledge about these procedures and how to best treat their patients.