LINNC 2019

Treating a recurrence of an Acom aneurysm using flow diversion

Live Cases Transmission Paris, France Bicêtre University Hospital

June 4, 2019 - 09:00-09:45
Conference room

Luisa BISCOITO, Fady CHARBEL, Tudor G. JOVIN, Giuseppe LANZINO, Michel E MAWAD, Tomoaki TERADA, Hongqi ZHANG

Jacques MORET, Laurent SPELLE

At 4-month follow-up, a 39-year-old male who received emergency treatment – coiling and remodeling – for a severe subarachnoid hemorrhage, is seen to have a recurrence at the base of the aneurysm.

Join Prof. Laurent Spelle, assisted by Drs. Cristian Mihalea (Roumania) and Thibault Jacquet as they re-treat an Acom aneurysm and daughter sac using a BALT SILK Vista Baby flow diverter. With commentary by Prof. Jacques Moret and the LINNC expert panel, follow the rationale behind this complex flow diversion strategy. Discover why the SILK Vista Baby was chosen for this procedure with its maneuverability or the fact that it can be navigated through a0.017” microcatheter. Learn about the role of the Sim&Cure simulation software in preparing the intervention: choosing the length of the device – simulating such aspects as the push within a precise anatomy – or determining the best distal landing site from which the proximal one will be planned. Follow each step of the procedure as the Prof. Spelle decides which branch to cover and which to preserve, his concerns about entering the small aneurysm at the base of the Acom complex with the flow diverter, or the use of the 3D roadmap in visualizing the origin of the A1 segment or dealing with the dysplastic nature of the vessels involved. Finally, as the flow diverter, which is deployed under compression, is seen to provide good apposition and neck coverage, enter the discussion about how to confirm the results and whether – and why –  it might still be necessary to do a control VASO-CT or regular CT.

As an added plus, check out the article by Igor Pagiola et al of the Bicêtre team offering insight into possible flow diversion stenting strategies based on anatomical considerations.

Pagiola I, Mihalea C, Caroff J, Ikka L, Chalumeau V, Yasuda T, Marenco de la Torre J, Iacobucci M, Ozanne A, Gallas S, Marques MC, Carrete H, Frudit ME, Moret J, Spelle L., “Flow diversion treatment of aneurysms of the complex region of the anterior communicating artery: which stent placement strategy should 'I' use? A single center experience.” J Neurointerv Surg. 2019 Nov;11(11):1118-1122. doi: 10.1136/neurintsurg-2019-014858. Epub 2019 Apr 11. PMID: 30975737.

 

Live case transmission Paris, France - Bicêtre University Hospital

This LIVE cases 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.

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