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What do we know about the nature of aneurysms themselves, and how does this impact our approach? How does size or placement affect our decision to treat or the strategy we employ? Join Prof. Jacques Moret and the LINNC Paris 2018 expert panel as they comment on a live case performed by Prof. Laurent Spelle assisted by Sophie Gallas (France) and Joaquin Marenco (Columbia) as we go beyond technique to the very nature of the disease and its treatment.
The case involves a 57- year-old woman with an unruptured MCA aneurysm discovered when she was successfully treated a year earlier with a remodeling technique for a ruptured Acom aneurysm. Stent-assisted coiling is chosen for treating the remaining unruptured aneurysm – but why? Enter the decision-making process as the panel explores an intervention which could be accomplished using a variety of different strategies…leading to the question of how, if there is no “right” way to approach an aneurysm, what informs our decisions? Experience? Knowledge? Simplicity? Why choose a laser cut stent and not a WEB device? What about flow diversion? Remodeling with coiling or using a braided stent with coiling? Does the upper branch give better coverage of the neck than the inferior branch? Would a flow divertor in the inferior branch be another choice? Does the upper branch give better coverage of the neck than the inferior branch? Would a flow divertor in the inferior branch be another choice?
The technique and tools employed are examined – in this case a Stryker Neuroform Atlas – with a discussion on the pros and cons of laser-cut stents, their wall apposition and maneuverability, the problems with their visibility which require a Vaso-CT to fully confirm neck coverage. The choice of coils is also discussed. What type to use: helical or spherical, etc.? The inherent danger of the “concept of the last coil” is underlined.
But the ultimate question, as one of the panelists explains, is philosophical. Is the disease a manifestation of the vessel wall or is the disease the sack itself? Is the ultimate solution for aneurysms endo-saccular or endo-luminal? Can there be one true answer for all aneurysms whether they are bifurcation aneurysms or side-wall aneurysms? What do you think? Join us here….
This LIVE case corresponds to the highest ethical standards in medicine and is 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.
