Symposium

With the spread of COVID-19 infection, there is concern about the maintenance of the emergency medical system, and the concept of “Protected Code Stroke” has been proposed, which places the highest priority on infection prevention for medical personnel. Please share with our members the information about the changes in the stroke codes that are different from the past, your efforts and difficulties. We welcome your reports on COVID-related strokes.

Three types of flow diverters and devices for bifurcation aneurysms, such as PulseRider and WEB, have been approved by the regulatory authorities. Will these new devices be the answer to the existing challenges of large aneurysms and bifurcation aneurysms? Many options have been presented for the treatment of cerebral aneurysms, and we will discuss the optimal treatment strategy for the future, including a comparison with existing techniques.

We have made great progress in our understanding of the disease and its pathogenesis, including epidemiology, advances in cerebrovascular anatomy from the perspective of endovascular treatment, and new diagnostic imaging. New treatment methods, such as transarterial embolization with liquid embolic material and selective transvenous embolization of the shunt, have also become popular. We are looking for presentations on epidemiology, diagnostic imaging, treatment, and other topics that will contribute to the next stage of dural arteriovenous fistulas.

With the establishment of thrombectomy for acute stroke, the indications are shifting from time-based to tissue-based. In order to achieve a good result, we need to use various imaging techniques in the shortest possible time. Consider the advantages and disadvantages of each policy, such as CT-based strategy, MR-based strategy, etc., and determine the most appropriate method.

Currently, three types of flow diverters have been approved by the regulatory authorities in Japan after completing clinical trials. Let’s discuss which flow diverter should be selected for which patients, the different therapeutic strategies, and the different uses of each flow diverter.

While double layer stents are now available, there are problems such as reduced supply of distal protection balloons. We will examine the treatment strategy for CAS high risk patients with fragile plaque, reduced renal function, and difficult approach.

New embolic materials, new devices such as microcatheters, and transvenous approaches are attracting attention. With the need for careful decisions regarding surgical interventions, to what extent is it appropriate for AVMs to be aggressively embolized? We will discuss from each standpoint whether endovascular treatment should aim for a single cure or refinement of the current combined treatment.

Pre-surgical tumor embolization is mainly performed from relatively safe vessels of the external carotid artery system. However, there are some cases in which embolization with high degree of difficulty is necessary to reduce the risk of surgical removal. We will discuss to what extent tumor embolization can contribute to the overall treatment from a risk-benefit perspective.

Some dural arteriovenous fistula cases are very tough to treat, such as those with repeated recurrence at the end of the occluded venous sinus or distal venous sinus, or those with multiple shunt points around the transverse venous sinus or in the cavernous sinus. We will share our experience in treating such refractory dural arteriovenous fistulas and discuss the optimal treatment strategy.

Endovascular treatment is generally regarded as a minimally invasive treatment, but there are various attempts to make it even less invasive, safer, and more satisfying for patients. We are looking for your spirits for further minimally invasive treatment by devising new techniques and devices, such as transradial artery approach and technology to reduce patient radiation exposure.

As research using computational fluid dynamics is becoming more widespread, it is becoming clearer what is possible and what is difficult. We would like JSNET members to know about other options to answer the question “Do I need to perform CFD analysis at my hospital? We would like to have presentations on “how to apply” CFD to actual clinical practice in various analysis environments.

In order to improve the outcome of acute recanalization therapy, it is important to establish inter-institutional collaboration and local medical care systems. We will discuss the most appropriate method for each region, such as the use of IV tPA, drip and ship, mother ship, direct angio suite, and pre-hospital scale.

The indications for flow diverter have been expanded for aneurysm size and location. This session will discuss the use of flow diverter, conventional neck bridge stent, or other options for moderate size aneurysms, IC-Pcom aneurysms, and vertebral artery aneurysms.

Regarding antiplatelet therapy in endovascular treatment, there is some consensus on the perioperative period. However, we have not yet reached a consensus on the criteria for dose reduction or discontinuation of antiplatelet agents in each treatment. Let’s find out the criteria by sharing our experiences and policies. We are also planning to conduct a nationwide survey, so please cooperate with us.

There is diversity among physicians and medical staff involved in endovascular treatment, including various generations, basic medical departments, and the activities of women. In actual practice, it is necessary to devise a way to combine these “diversities” into “one team” and make it function. We will also focus on work style reform and discuss issues related to working styles.

In educating young doctors, I think it is more efficient to teach them not only techniques, but also “treatment concepts” based on the pathophysiology of the disease. An understanding of development and functional anatomy will also be necessary. We would like to hear about your experiences and methodologies at your institution regarding the educational system for conveying the “spirit of endovascular treatment”.

It is essential to become an academic physician to feel clinical questions and to think about them carefully. In addition, technology is needed to logically translate these questions into clinical research. We are planning a symposium to learn the methodology of clinical research, including basic statistical analysis, in an easy-to-understand manner. Presentations of actual clinical research cases are also welcome.

High resolution MRI, CT, and cone-beam CT with angiography have enabled us to visualize pathophysiology and microvascular anatomy, which were previously impossible. In this session, we will discuss how far these advanced cerebrovascular imaging techniques can approach to the anatomy and pathology.

We are looking for presentations on research on basic approaches, robot technology, AI, computer simulation, and other research that will lead to the future of endovascular treatment.

Many devices are competing with each other, and it is now possible to perform thrombectomy for medium vessel occlusions, which were not covered in RCTs. On the other hand, in the real world, it is often difficult to decide how far to pursue and where to stop the procedure. Does that one move lead to good results?　We will discuss the therapeutic indications for peripheral arterial occlusion with a view to building scientific evidence.

There is evidence in RCTs for acute recanalization of the anterior circulation. Another challenge is the treatment of occlusion of the posterior circulation. Factors that determine the outcome of treatment for occlusion of the posterior circulation, including preoperative imaging, therapeutic techniques and devices, will be discussed.