AVM contest - ALICE/SLICE Challenge

AVM Contest Session – ALICE/SLICE Workshop

This was one of the most engaging and creative case-based sessions I’ve watched recently. Dr. Rene Chapot made a humorous entry wearing a hat that read, “Make AVM Great Again,” setting the tone for a fun yet intellectually rigorous AVM contest. Two expert teams participated, Team A with Dr. Adnan Siddiqui and Team B with Dr. Xavier Barreau and Dr. Vipul Gupta, working on a silicon 3D AVM model designed by Dr. Chapot to simulate live conditions.

The AVM was a compact, unruptured nidus in the left temporal region, presenting with epilepsy. It had a small posterior circulation feeder and two major MCA feeders, with venous drainage through two superficial veins that converged into the vein of Trolard and superficial middle cerebral vein. After occluding the posterior feeder, the challenge focused on anterior circulation feeders.

A highlight of the session was the dual-colour fused 3D microcatheter angiography, which visually delineated the arterial components and their convergence into a shared venous outflow, marked by a purple hue. Dr. Chapot emphasized that identifying the venous convergence point was the most critical anatomical detail to plan curative treatment.

Team A used a transvenous strategy with a coil anchor at the venous confluence and squid injection from a second microcatheter. Team B used a trans arterial dual-microcatheter “pressure cooker” technique. As the squid entered venous lakes prematurely in Team B’s case, Dr. Chapot pointed out that this often impedes penetration into smaller feeders, increasing the risk of incomplete cure or rupture.

Team A's transvenous approach, achieved an excellent angiographic cure in the model, while Team B's trans arterial cast showed partial nidus filling on control angiography. It’s hard not to admire the technical finesse and strategic clarity demonstrated by Team A, and Dr. Chapot deservedly declared them the winners of the contest. Interestingly, he later revealed that in the actual patient, he had employed the same transvenous strategy that Team A used, again validating its efficacy.

What elevated this session even more was the format itself. The contest setup, combined with live commentary, real-time decision-making, and humour, made it one of the most memorable academic exercises I’ve attended. I strongly believe this model of learning, immersive, competitive, and collaborative, can be transformative for neurovascular education. It breaks away from static PowerPoint lectures and data-heavy presentations and brings procedural nuance to the forefront.

In conclusion, this AVM contest session was more than a demonstration of technique; it was a shift in paradigm. It reminded us that treatment strategies must constantly evolve with technology, anatomy must be understood in full 3D, and above all, learning can be serious without being solemn. I walk away from this session more convinced than ever to explore venous anatomy in detail, incorporate fused imaging in my planning, and when the right case presents itself, cautiously attempt a transvenous curative embolization.