ESMINT Webinar

The registration for the ESMINT Webinar 9 "Analysis and EVT of AV-shunt lesions in the spinal canal - Part II" by Profs. Isabel Wanke and Daniel A. Rüfenacht is open. See below for more details.

About the ESMINT Webinars

ESMINT is broadcasting live webinars on endovascular therapies. Be ready for ESMINT's webinars to follow a 30 - 60 minutes session provided by a top expert in neurovascular therapies. 

The webinar will consist of a 20 minutes talk followed by a live interactive discussion. The topics will systematically cover the actual questions in acute ischemic and hemorrhagic stroke therapies.

The participation at the webinar is free of charge for ESMINT members who are also able to view the recorded webinars afterwards. The registration fee for non-members is 50 EUR (no VAT).

Next webinar:

AVM Webinars

ESMINT Webinar 9: Analysis and EVT of AV-shunt lesions in the spinal canal - Part II

Date: November 6, 2017
Topic: Analysis and EVT of AV-shunt lesions in the spinal canal - Part II
Speaker: Prof. Daniel Rüfenacht and Prof. Isabel Wanke, Switzerland

Please register as ESMINT member here.

As non-member, please join ESMINT or pay for one webinar access.

For more information about the webinar, please see below.

Please download the Spinal Angiography Reporting Cartoon.

Speaker

Prof. Isabel Wanke

Board certified in Germany for Radiology and Neuroradiology.

1992-2007 Postgraduate Training and clinical activity in Radiology and Neuroradiology at the MGH in Boston, USA (Harvard Medical School - J. Thrall, B. Rosen), and at the University Hospital of Essen, Germany (Prof. F. Zanella, Prof. H.C. Diener, Prof. M. Forsting).

Prof. Daniel A. Rüfenacht

Swiss board certified in Radiology and Neuroradiology.

1981-1987 Postgraduate training in radiology and neuroradiology at the Univ. Hospital of Berne (Prof. P. Huber) and in interventional neuroradiology in 1984-85 at Univ. VII of Paris, France (Prof. J.J.Merland).

1988-1992 work in US with stays at Univ. of Wisconsin, Madison, WI; Mayo Clinic, Rochester, MI; and Univ. of Minnesota, Minneapolis, MI.

Co-founders of ICS (2004), ESMINT (2008), ESMINT/ANIC teaching course (2008) and SwissNeuroFoundation (2013). Former treasurers of ESMINT. Co-initiators of the AneurysmDataBase / SwissNeuroFoundation project with 3D-shape analysis based categorization services (in collaboration with VPH-SHARE, ICS and AneuX).

Key message

Understanding spinal vascular anatomy and type of AV lesion allows for assessing risks and for providing treatment.

Learning objectives

“What type of AV lesion?”

  • topographic position of an AV-shunt
  • how many AVFs? sizes of AVFs?
  • arteries? veins? relation to normal spinal cord vessels?

“Is there a need to treat?”

  • type of cord edema? Subarchanoid or intramedullary hemorrhage? neurovascular conflict?
  • involvement of spinal cord venous drainage (VHT)?

“How to occlude AV-shunts avoiding damage to the normal cord”.

  • liquid embolics? particles? coils?
  • additional medication?

Detailed information about "Analysis and EVT of AV-shunt lesions in the spinal canal"

This educational review approaches the problem through the questions “what type of AV lesion?”, “is there a need to treat?” and “how to occlude AV-shunts avoiding damage to the normal cord”. The well-known classification proposed by R. Djindjian and J-J. Merland is applied and we wish to provide additional information on current disease understanding and on current endovascular treatment options. Both have evolved, the disease understanding thanks to vascular research unraveling the basic mechanisms of vessel wall pathologies and endovascular treatment options thanks to technological developments allowing for increased control of implant delivery and optimized implant choice and quality.

There is nowadays quite some understanding on how both, thrombus and blood flow, interfere with the vessel wall and therefore how malformed, at birth already present spinal AVM and AVF or later acquired dural AVF evolve from stable to unstable lesions and may become symptomatic over time. The most frequent observed critical impact of an AVM/F is by disturbing the spinal cord capacity to resorb CSF. Venous hypertension (VHT) is producing a cord edema in the involved draining area, presenting usually as ascending cord edema. Imaging and clinical observations have helped to understand how VHT is gradually installing and why it may be opportune to treat SDAVF or small SAVF and small SAVM already prior to edema formation.

Focal, pulsatile irritation by a pulsating vascular ectasia extending into the spinal cord is capable of producing a different type of CSF resorption problem with an edema expanding into adjacent cord segments in both directions, upwards and downwards.

With advancement of endovascular treatment technology, many AV-shunts of vascular malformations can be selectively obliterated and the normal vasculature of the spinal cord can be preserved. However, for reasons of critical normal supply to the spinal cord to be respected, it may be difficult and not advisable to intend curing some SAVM, such as intramedullary AVM with main supply from the anterior spinal artery axis, where too aggressive endovascular or surgical attempts would jeopardize spinal cord function. Targeted, partial treatment of these SAVM is often alleviating from symptoms and likely also from risk of hemorrhage. Successful partial such treatment followed by close watch of the further evolution of a SAVM may provide the outline on how to better address in the future other AVMs of the CNS in times of changing disease understanding and evolving technology.

Organisational matters

The places in the live webinar room are limited and are on a first come, first serve basis. Please make sure to arrive in the room around 5 minutes in advance.

If you attend an ESMINT webinar the first time, please read the Webinar Access Information in order to be able to join the meeting.

Previous ESMINT Webinars:

ESMINT Webinar 8

Date: October 9, 2017
Topic: Analysis and EVT of AV-shunt lesions in the spinal canal - Part I
Speaker: Prof. Daniel Rüfenacht and Prof. Isabel Wanke, Switzerland

Watch the recording of the ESMINT Webinar 8 (for ESMINT members only)

ESMINT Webinar 7

Date: September 25, 2017 | 17:30h
Topic: Unruptured AVM: How to approach, when to treat and when not to?
Speaker: Prof. Laurent Spelle, France

Watch the recording of the ESMINT Webinar 7 (for ESMINT members only)

Stroke Webinars

ESMINT Webinar 6

Date: July 3, 2017 | 17:30h
Topic: Tandem occlusions: To stent or not to stent
Speaker: Prof. Thomas Liebig, Germany

Watch the recording of the ESMINT Webinar 6 (for ESMINT members only)

ESMINT Webinar 5

Date: June 12, 2017 | 17:30h
Topic: Stroke: Complications and their treatment
Speaker: Prof. Jan Gralla, Switzerland

Watch the recording of the ESMINT Webinar 5 (for ESMINT members only).

ESMINT Webinar 4

Date: May 8, 2017 | 17:30h
Topic: How to approach a cervical dissection in acute stroke
Speaker: Dr. Paolo Machi, Geneva, Switzerland

Watch the recording of the ESMINT Webinar 4 (for ESMINT members only).

ESMINT Webinar 3

Date: April 24, 2017 | 17:30h
Topic: Clot and technique: how to optimize mechanical thrombectomy
Speaker: Prof. Tommy Andersson, Stockholm

Watch the recording of the ESMINT Webinar 3 (for ESMINT members only).

ESMINT Webinar 2

Date: March 27, 2017 | 17:30h
Topic: Imaging based patient selection for acute stroke treatment
Speaker: Prof. Jens Fiehler, Germany

Watch the recording of the ESMINT Webinar 2 (for ESMINT members only).

Introductory webinar

ESMINT Webinar 1

Date: March 6, 2017 | 17:30h
Speaker: Prof. Edoardo Boccardi, Italy
Topic: Flow diverters for aneurysms with branch from the sac

Watch the recording of the ESMINT Webinar 1 (for ESMINT members only).