Complication 02 - SLICE Next Frontiers 2022

LIVE CASE

13 / 13 episodes

01
5
Vincent COSTALAT , Paolo Machi , Vitor Mendes Pereira , Federico Cagnazzo , michel piotin , Francisco José Mont' Alverne , anne christine JANUEL , Dhaval Thakkar

LIVE CASE 01: Extradural giant aneurysms - SLICE Next Frontiers 2022

01
Vitor Mendes Pereira , Tufail Patankar , michel piotin , Adnan Siddiqui , Jean-Christophe GENTRIC

LIVE CASE 03: Yves Moulin & Paulina Hachette - SLICE Next Frontiers 2022

02
Vitor Mendes Pereira , Tufail Patankar , michel piotin , anne christine JANUEL , Adnan Siddiqui , Jean-Christophe GENTRIC

LIVE CASE 02: Giant cavernous aneurysm treatment - SLICE Next Frontiers 2022

03
Vincent COSTALAT , Paolo Machi , Federico Cagnazzo , Tufail Patankar , Francisco José Mont' Alverne , anne christine JANUEL , Waleed Brinjikji , RAPHAEL BLANC , Jean-Christophe GENTRIC , Helena Guerreiro

LIVE CASE 05: Recanalization of top-of-the basilar aneurysms after simple coiling

05
Vincent COSTALAT , Vitor Mendes Pereira , Francisco José Mont' Alverne , Waleed Brinjikji , Adnan Siddiqui , RAPHAEL BLANC , Jean-Christophe Gentric

Complication 03 - SLICE Next Frontiers 2022

06
3.5
Paolo Machi , Vitor Mendes Pereira , Federico Cagnazzo , Tufail Patankar , michel piotin , Francisco José Mont' Alverne , Waleed Brinjikji , Adnan Siddiqui , Arianna Rustici , Flavio Andresciani

LIVE CASE 04: Axel Bilbon - SLICE Next Frontiers 2022

07
4.3
Vincent COSTALAT , Paolo Machi , Federico Cagnazzo , anne christine JANUEL , Adnan Siddiqui , RAPHAEL BLANC , Jean-Christophe GENTRIC , Flavio Andresciani

LIVE CASE 06: 10mm size MCA aneurysm - SLICE Next Frontiers 2022

08
Vincent COSTALAT , Vitor Mendes Pereira , Francisco José Mont' Alverne , Waleed Brinjikji , Adnan Siddiqui , RAPHAEL BLANC

LIVE CASE 07: Endovascular treatment of MCA- SLICE Next Frontiers 2022

09
4.5
Vincent COSTALAT , Paolo Machi , Vitor Mendes Pereira , anne christine JANUEL , Waleed Brinjikji , BOURCIER romain , Adnan Siddiqui , Arianna Rustici , Manisha Joshi

LIVE CASE 08: Wide neck-bifurcation aneurysms - SLICE Next Frontiers

10
Vincent COSTALAT , Vitor Mendes Pereira , michel piotin , Tufail Patankar , Francisco José Mont' Alverne , BOURCIER romain , Adnan Siddiqui , Dhaval Thakkar , Arianna Rustici , Helena Guerreiro

LIVE CASE 09: David Plateau - SLICE Next Frontiers 2022

11
Vincent COSTALAT , Vitor Mendes Pereira , Federico Cagnazzo , Tufail Patankar , michel piotin , Francisco José Mont' Alverne , BOURCIER romain , Adnan Siddiqui , Dhaval Thakkar , Arianna Rustici , Helena Guerreiro

LIVE CASE 10: Alexandro Pretro - SLICE Next Frontiers 2022

12
Vincent COSTALAT , Vitor Mendes Pereira , Tufail Patankar , Francisco José Mont' Alverne , Adnan Siddiqui , RAPHAEL BLANC , Jean-Christophe GENTRIC

Complication 01 - SLICE Next Frontiers 2022

4.8
Vincent COSTALAT , Paolo Machi , Federico Cagnazzo , Tufail Patankar , Adnan Siddiqui , Jean-Christophe GENTRIC , Manisha Joshi

Complication 02 - SLICE Next Frontiers 2022

Complication

What's one of the worst scenarios for WEB embolization? It's migration

Web is one of the safest devices on the market, simple to use and very efficient.
When you use a coil, there is a risk for it to migrate out of the aneurysm, it’s the same risk when you use a web device. The risk now is to deal with those migrations.Doctor Tufail Patankar's quotation: “This isn’t an uncommon problem […] It doesn’t get reported because it doesn’t get published or presented”

How to prevent the migration of your device:

  • The risk is higher using the 17 system and small web sizes for small aneurysms.
  • Sizing is very important, there is a tendency to undersize the device which will determine loose wall apposition and a risk of distal migration.
  • The risk is higher in high-flow situations T-basilar / T-carotid and the risk if higher if forceful contrast injections are being made immediately after deploying in these positions.
  • Always use simulation to be able to see that your device is not undersized and that it will have good wall apposition. 
  • Ensure that you push your devices inside the sac, do not detach the device unless you are sure that it is well apposed in the aneurysmal sac. Vaso-CT before detachment may clarify it.

Doctor Adnan Siddiqui's quotation:

In the following cases, the web devices have been moved from their original location. We are using two differents devices to try to get them.

How to remove a distally migrated WEB-device:

  • When you are dealing with any complication, remember to the first point is not to make the matter worse!
  • Ensure you switch your system to a tri-axial one:
    1. Ideally use a 6-FR distal access catheter (you need good navigability and proper internal lumen);
    2. 5-Fr distal access catheter may be enough (but you take the risk of not being able to ingest the WEB);

Doctor Ricardo Hanel's quotation:

  • Try to pass the WEB with a 0.21 microcatheter on a 0.14 guidewire, use gentle torquing movements, you should be able to pass between the WEB and the wall of the artery. If you feel passing with a guidewire is to dangerous you can also pass with the empty catheter. Once you pass the WEB there are two options:
    1. Deploy a stent-retriever (like Solitaire 4x40);
    2. Deploy a micro snare through the 0.21 microcatheter and catch the WEB in a distal to proximal fashion.

  • Once you catch the WEB with either approach, you should advance your distal access catheter to the WEB and try to pin it between your micro snare/stent-retriever and the distal access catheter. Try to ingest it if possible, if not perform a WEB-ectomy manoeuvre while pulling everything.
  • If passing with a 0.21 microcatheter is not working, it is possible to pass with a 0.17 microcatheter and use a 0.17 compatible stent-retriever (ex. Tiger6retriever), with this technique you will be able to control the actual level of inflation of your stent during the retrievel maneuver inside the aspiration device.
  • Theoretically the WEB is a compressible device, if you are not able to retrieve it – the last resort option would be to stent it to the vessel wall. Ideally, deploy a Solitaire AB and perform a vasoCT. If you think that the result is acceptable and the WEB is compressed you may detach. 

In the bloc B, the doctor Vitor Mendes Pereira (Toronto, Canada) is using a tigertriever 17 by RapidmedicalDoctor Vitor Mendes Pereira's quotation:

Our expert analyst, Doctor Razvan Radu from CHU Montpellier, France


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LIVE CASE

13 / 13 episodes

01
5
Vincent COSTALAT , Paolo Machi , Vitor Mendes Pereira , Federico Cagnazzo , michel piotin , Francisco José Mont' Alverne , anne christine JANUEL , Dhaval Thakkar

LIVE CASE 01: Extradural giant aneurysms - SLICE Next Frontiers 2022

01
Vitor Mendes Pereira , Tufail Patankar , michel piotin , Adnan Siddiqui , Jean-Christophe GENTRIC

LIVE CASE 03: Yves Moulin & Paulina Hachette - SLICE Next Frontiers 2022

02
Vitor Mendes Pereira , Tufail Patankar , michel piotin , anne christine JANUEL , Adnan Siddiqui , Jean-Christophe GENTRIC

LIVE CASE 02: Giant cavernous aneurysm treatment - SLICE Next Frontiers 2022

03
Vincent COSTALAT , Paolo Machi , Federico Cagnazzo , Tufail Patankar , Francisco José Mont' Alverne , anne christine JANUEL , Waleed Brinjikji , RAPHAEL BLANC , Jean-Christophe GENTRIC , Helena Guerreiro

LIVE CASE 05: Recanalization of top-of-the basilar aneurysms after simple coiling

05
Vincent COSTALAT , Vitor Mendes Pereira , Francisco José Mont' Alverne , Waleed Brinjikji , Adnan Siddiqui , RAPHAEL BLANC , Jean-Christophe Gentric

Complication 03 - SLICE Next Frontiers 2022

06
3.5
Paolo Machi , Vitor Mendes Pereira , Federico Cagnazzo , Tufail Patankar , michel piotin , Francisco José Mont' Alverne , Waleed Brinjikji , Adnan Siddiqui , Arianna Rustici , Flavio Andresciani

LIVE CASE 04: Axel Bilbon - SLICE Next Frontiers 2022

07
4.3
Vincent COSTALAT , Paolo Machi , Federico Cagnazzo , anne christine JANUEL , Adnan Siddiqui , RAPHAEL BLANC , Jean-Christophe GENTRIC , Flavio Andresciani

LIVE CASE 06: 10mm size MCA aneurysm - SLICE Next Frontiers 2022

08
Vincent COSTALAT , Vitor Mendes Pereira , Francisco José Mont' Alverne , Waleed Brinjikji , Adnan Siddiqui , RAPHAEL BLANC

LIVE CASE 07: Endovascular treatment of MCA- SLICE Next Frontiers 2022

09
4.5
Vincent COSTALAT , Paolo Machi , Vitor Mendes Pereira , anne christine JANUEL , Waleed Brinjikji , BOURCIER romain , Adnan Siddiqui , Arianna Rustici , Manisha Joshi

LIVE CASE 08: Wide neck-bifurcation aneurysms - SLICE Next Frontiers

10
Vincent COSTALAT , Vitor Mendes Pereira , michel piotin , Tufail Patankar , Francisco José Mont' Alverne , BOURCIER romain , Adnan Siddiqui , Dhaval Thakkar , Arianna Rustici , Helena Guerreiro

LIVE CASE 09: David Plateau - SLICE Next Frontiers 2022

11
Vincent COSTALAT , Vitor Mendes Pereira , Federico Cagnazzo , Tufail Patankar , michel piotin , Francisco José Mont' Alverne , BOURCIER romain , Adnan Siddiqui , Dhaval Thakkar , Arianna Rustici , Helena Guerreiro

LIVE CASE 10: Alexandro Pretro - SLICE Next Frontiers 2022

12
Vincent COSTALAT , Vitor Mendes Pereira , Tufail Patankar , Francisco José Mont' Alverne , Adnan Siddiqui , RAPHAEL BLANC , Jean-Christophe GENTRIC

Complication 01 - SLICE Next Frontiers 2022

4.8
Vincent COSTALAT , Paolo Machi , Federico Cagnazzo , Tufail Patankar , Adnan Siddiqui , Jean-Christophe GENTRIC , Manisha Joshi

Complication 02 - SLICE Next Frontiers 2022

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