22nd Annual

Interventional Neuroradiology Symposium

& 7th Annual Karel G. Terbrugge Lectureship & Neurovascular Anatomy Workshop

September 22-24, 2022 – BMO Education & Conference Centre, Toronto, CA (Hybrid)

Co-Organized by the Department of Medical Imaging, University of Toronto and the Department of Diagnostic Imaging, Hospital for Sick Children (SickKids)

Learning Objectives

Day 1 – External Carotid Artery and Spinal Vascular Anatomy and Diseases

At the end of this day, participants should be able to:

  1. Recognize the normal and abnormal angioarchitecture of the external carotid artery (ECA) and spine region.
  2. Use the above knowledge to formulate a differential diagnosis of various vascular abnormalities in these regions – including vascular tumors, AVMs and dural AVFs.
  3. Compare different treatment options and discuss the best treatment strategy for each vascular disease patient.

Presenters

 

Kim Nelson – ECA Embryology

Date:   Thurs, Sept 22, 2022                                      Time:   0800 -0830

After this session, the participants should be able to:

  1. Describe the embryology that leads to different anatomical variants of the ECA
  2. Analyze different variations of the ECA and how they may impact treatment and clinical outcome in intracranial vascular diseases.

Maksim Shapiro – The ascending pharyngeal artery

Date:   Thurs, Sept 22, 2022                                      Time:   0830-0900

After this session, the participants should be able to:

  1. Name the possible territories of the ascending pharyngeal artery and its cranial nerve supply.
  2. Recognize the dangerous anastomoses between the ascending pharyngeal artery and intracranial arteries.
  3. Discuss the safest route of treatment for tumors and various vascular diseases based on the above knowledge.

Maksim Shapiro – Meningeal Arteries

Date:   Thurs, Sept 22, 2022                                      Time:   0900-0930

After this session, the participants should be able to:

  1. Recognize the normal territories and variations of the meningeal arteries.
  2. Identify when and where the arteries of the brain can participate in the supply of the dura.
  3. Apply the above knowledge in dural lesion interventions.

Karel Terbrugge – CASE DISCUSSIONS Epistaxis

Date:   Thurs, Sept 22, 2022                                      Time:   1000-1030

After this session, the participants should be able to:

  1. Recognize the clinical and imaging characteristics of the various causes of epistaxis.
  2. List the indications and contraindications for endovascular management of epistaxis
  3. Name the transcranial vascular anastomosis and their relevance to endovascular epistaxis treatment.

Waleed Brinjikji – CASE DISCUSSIONS Paragangliomas

Date:   Thurs, Sept 22, 2022                                      Time:   1030-1100

After this session, the participants should be able to:

  1. Recognize the imaging characteristics and angioarchitecture of Paragangliomas.
  2. Summarize the risk and benefits of pre-operative embolization for Paragangliomas.
  3. Discuss different types of embolic materials and their pros and cons for pre-operative tumor embolization.

Timo Krings – CASE DISCUSSIONS Juvenile Angiofibromas (JAF)

Date:   Thurs, Sept 22, 2022                                      Time:   1100-1130

After this session, the participants should be able to:

  1. Identify the neurovascular anatomy relevant for JAF.
  2. Review the current methods to treat JAF.
  3. Identify potential complications in endovascular JAF treatment.

Jai Jai Shankar – CASE DISCUSSIONS Embolizing the MMA: CSDH & Meningeomas / Tips & Tricks

Date:   Thurs, Sept 22, 2022                                      Time:   1130-1200

After this session, the participants should be able to:

  1. Describe the pathophysiology of chronic subdural hematoma.
  2. Identify when embolization of middle meningeal artery for treatment of chronic subdural hematoma is indicated.
  3. Discuss the risks for embolization of middle meningeal artery.

Timo Krings – Spinal Vascular Anatomy

Date:   Thurs, Sept 22, 2022                                      Time:   1300 – 1330

After this session, the participants should be able to:

  1. Recognize the clinical importance of spinal vascular anatomy.
  2. State the current imaging strategies to demonstrate spinal vascular anatomy.
  3. Report clinical symptomatology related to disorders of the venous vascular outflow.

Timo Krings – Classification of Spinal Vascular Diseases

Date:   Thurs, Sept 22, 2022                                      Time:   1330 – 1400

After this session, the participants should be able to:

  1. Recognize the different types and pathogenesis of spinal vascular diseases.
  2. Describe the clinical symptomatology of different spinal vascular diseases.
  3. Diagnoses patients with spinal vascular diseases based on clinical and imaging findings.

Tao Hong – Genetic Pathways in Spinal AVM

Date:   Thurs, Sept 22, 2022                                      Time:   1400 – 1430

After this session, the participants should be able to:

  1. Recognize the genetic homogeneity in spinal and brain arteriovenous malformations.
  2. Describe the KRAS/BRAF pathway as the main genetic mechanism of spinal arteriovenous malformations.
  3. Describe MAP3K3 and PIK3CA as the main genetic mechanism of brain and spinal cavernous malformations.

Donatella Tampieri – Shunting Lesions of the Spine: Imaging

Date:   Thurs, Sept 22, 2022                                      Time:   1430 – 1500

After this session, the participants should be able to:

  1. Differentiate the different spinal vascular lesions based on their imaging characteristics.
  2. Combine the above knowledge with the clinical symptoms to formulate the most likely diagnoses for patients with spinal vascular abnormalities.
  3. Recommend the most appropriate imaging modality for patients with suspected spinal vascular abnormalities.

Joshua Hirsch – A rational approach to Spine Interverventions

Date:   Thurs, Sept 22, 2022                                      Time:   1530 – 1600

After this session, the participants should be able to:

  1. Identify different Percutaneous discal treatment options, their indications, risks, and how to perform them.
  2. Debate modern day spinal augmentation with a focused review on mortality.
  3. Discuss future trends in spine care.

Eef Hendriks – CASE DISCUSSIONS Spinal Dural Arteriovenous fistula (dAVF)

Date:   Thurs, Sept 22, 2022                                      Time:   1600-1630

After this session, the participants should be able to:

  1. Describe the imaging characteristics of spinal DAVFs.
  2. State the pros and cons of surgery versus endovascular treatment for spinal dAVFs.
  3. Recognize the different variant types of spinal dAVF.

Hong Qi Zhang – CASE DISCUSSIONS Spinal AVMs

Date:   Thurs, Sept 22, 2022                                      Time:   1630-1700

After this session, the participants should be able to:

  1. Recognize the role of embolization in Spinal cord AVM treatment.
  2. Describe different embolization techniques that can be used in Spinal AVMs.
  3. Evaluate the outcome of hybrid surgery in Spinal AVM treatment.

Day 2 – INR Symposium

At the end of this day, participants should be able to:

  1. Integrate the knowledge of transvenous embolizations in the decision making for treatment of various intracranial diseases, including intracranial hypotension, spinal and cranial AVMs and dAVFs.
  2. Discuss and analyze the current literature for pros and cons in new advances of intracranial endovascular treatment, such as Stentrodes, Flow diversion for distal aneurysms, distal thrombectomy.
  3. Compare and discuss the different treatment strategies for unusual patients with brain AVMs and dAVFs, including pediatric patients and those with unusual angioarchitecture.

Presenters

Richard Farb – Detecting intracranial Hypotension: the TWH Approach

Date:   Fri, Sept 23, 2022                                          Time:   0800-0820

After this session, the participants should be able to:

  1. Recognize the clinical symptoms of intracranial hypotension.
  2. Recommend the appropriate imaging modality for evaluation patients with intracranial hypotension.
  3. Describe imaging characteristics of intracranial hypotension, particularly those with Cerebrospinal fluid (CSF) leakage.

Transvenous Embolizations for intracranial Hypotension the Mayo Experience

Waleed Brinjikji – Rochester, Patrick Nicholson – Toronto

Date:   Fri, Sept 23, 2022                                          Time:   0820-0840

After this session, the participants should be able to:

  1. Recognize the indications for transvenous embolization of CSF leaks.
  2. Examine the example cases and discuss the treatment strategies and their outcomes.

Workup and endovascular Management of Pulsatile Tinnitus

Patrick Nicholson – Toronto

Date:   Fri, Sept 23, 2022                                          Time:   0840-0900

After this session, the participants should be able to:

René Chapot – Transvenous Embolizations for spinal AVMs and spinal dAVFs

Date:   Fri, Sept 23, 2022                                          Time:   0900-0920

After this session, the participants should be able to:

  1. Recognize the indications and risks for transvenous embolization of spinal AVMs and spinal dAVFs.
  2. Examine the example cases and identify patients who would benefit from transvenous embolization over transarterial embolization.

René Chapot – Transvenous Embolizations for Brain AVMs

Date:   Fri, Sept 23, 2022                                          Time:   0920-0950

After this session, the participants should be able to:

  1. Determine the indications and contraindications for transvenous embolization of brain AVMs.
  2. Detect potential complications from transvenous embolization for brain AVMs.
  3. Examine the example cases and discuss treatment strategies for each brain AVM patient.

Thomas Oxley – Stentrodes – The story so far

Date:   Fri, Sept 23, 2022                                          Time:   1030-1100

After this session, the participants should be able to:

  1. Describe what Stentrodes are and how they can be implanted in the brain.
  2. Identify patients who would likely benefit from Stentrodes.

Andres Lozano – The Neurosurgical Perspective

Date:   Fri, Sept 23, 2022                                          Time:   1100-1130

After this session, the participants should be able to:

  1. Summarize the concepts of neuromodulation.
  2. Describe Deep Brain Stimulation and its indications.
  3. Discuss brain targets for different diseases.

Kartik Bhatia – Relationship of Vascular Structures and Functional Neurosurgical Targets

Date:   Fri, Sept 23, 2022                                          Time:   1130-1150

After this session, the participants should be able to:

  1. Identify the closest accessible vessels adjacent to neurosurgical targets for brain stimulation.
  2. Assess the distance between targets and adjacent accessible vessels.
  3. Choose the best stimulation targets for approach by endovascular means.

Pascal Mosimann – Thrombectomy for distal clots – is there evidence?

Date:   Fri, Sept 23, 2022                                          Time:   1300 – 1330

After this session, the participants should be able to:

  1. Discuss the current literature about distal thrombectomy and its potential indications.
  2. Identify possible complications of distal thrombectomy
  3. Examine and discuss the treatment strategies of the example cases and their outcomes.

Vitor Pereira – Flowdiversion for distal arterial aneurysms (AA) – Is there evidence?

Date:   Fri, Sept 23, 2022                                          Time:   1330 – 1400

After this session, the participants should be able to:

  1. Discuss the current literature about flowdiversion for distal AAs.
  2. Describe the pros and cons of treating distal AAs with flowdiverters.
  3. Identify potential complications of flowdiverters in distal AA treatment.

Daniel Roy – Endovascular Treatment for Brain AVMs – is there evidence?

Date:   Fri, Sept 23, 2022                                          Time:   1400 – 1430

After this session, the participants should be able to:

  1. Discuss on the wide range of reported success rates of endovascular treatment for brain AVMs in terms of occlusion and complication rates.
  2. Analyze and interpretate theses rates as reported from the registry sub-group from the TOBAS trial.

J Mocco – Intracerebral hemorrhage (ICH) : A disease that should be treated minimal invasively?

Date:   Fri, Sept 23, 2022                                          Time:   1430 – 1500

After this session, the participants should be able to:

  1. Describe the concept of aspiration of ICH.
  2. Identify indications for ICH treatment.
  3. Report complications associated with ICH treatment.

Timo Krings – CASES: Dural Supply in pial  AVMs, pial supply in dural AVFs

Date:   Fri, Sept 23, 2022                                          Time:   1530 – 1600

After this session, the participants should be able to:

  1. Explain why it is important to understand the pial supply in dural AVF management.
  2. Explain why it is important to understand the dural supply in pial AVM treatment.
  3. Identify different subtypes of pial supply in dural AVF.

Ivan Radovanovic – CASES: Combined Surgical and endovascular approaches in AVMs and dAVFs

Date:   Fri, Sept 23, 2022                                          Time:   1600 – 1630

After this session, the participants should be able to:

  1. Discuss the rationale for combined surgical and endovascular approaches for AVMs and dAVFs.
  2. Examine the cases and discuss treatment strategies for each patient.

Prakash Muthusami – CASES: Pediatric Shunts  – Recent cases, recent developments

Date:   Fri, Sept 23, 2022                                          Time:   1630 – 1700

After this session, the participants should be able to:

  1. Identify the spectrum of neurovascular arteriovenous shunts in children.
  2. Discuss the treatment considerations, including the indications and potential complications.
  3. Differentiate the treatment difference in adults versus children.

Day 3 – INR Symposium

At the end of this day, participants should be able to:

  1. Discuss recent advances in stroke treatment.
  2. Examine and choose treatment strategies for patients with stroke.
  3. Identify the building blocks of an INR service.
  4. Analyze and discuss the difficulties of being an interventional neuroradiologist.

 

Presenters

Timo Krings – Anatomical Considerations for Intracranial Atherosclerotic Disease (ICAD)

Date:   Sat, Sept 24, 2022                                         Time:   0800 – 0820

After this session, the participants should be able to:

  1. Assess the different types of ICAD related stroke mechanisms.
  2. Review endovascular management strategies of ICAD.
  3. Report salient imaging features of high-risk anatomies for endovascular ICAD treatment.

Joanna Schaafsma – New Drugs for Stroke Treatment and Prevention

Date:   Sat, Sept 24, 2022                                         Time:   0820 – 0840

After this session, the participants should be able to:

  1. Describe the risks and benefits of add-ons to thrombolytics in acute stroke.
  2. Summarize the updates on neuroprotective agents.
  3. Discuss novel approaches for the secondary prevention of ischemic and hemorrhagic stroke and their indications.

Raul Nogueira – Oxygen Carriers for Acute Stroke

Date:   Sat, Sept 24, 2022                                         Time:   0840 – 0900

After this session, the participants should be able to:

  1. Identify the different types of oxygen carriers and how they work.
  2. Summarize the recent studies and their results of the use of oxygen carriers in acute stroke.
  3. Discuss indications and contraindications of administrating oxygen carriers in acute stroke patients.

Blaise Baxter – Hyperacute  Stroke Detection: In-Ambulance CT, Ultrasound or …AI?

Date:   Sat, Sept 24, 2022                                         Time:   0900 – 0920

After this session, the participants should be able to:

  1. Describe the various tools available for screening and identifying large vessel occlusion (LVO) stroke patients.
  2. Summarize the strengths and weaknesses of the LVO screening tools.
  3. Apply how LVO screening tools can be used in stroke networks to gain efficiencies and improve treatment times to revascularization.

Hal Rice – Clot Composition Detection: Why, How?

Date:   Sat, Sept 24, 2022                                         Time:   0920 – 0940

After this session, the participants should be able to:

  1. Discuss how clot composition can help establish the cause of stroke.
  2. Associate certain imaging characteristics with different clot compositions.
  3. Use the knowledge about clot composition to determine the treatment strategy for stroke patients.

Andrew Demchuk – Current trials for Stroke

Date:   Sat, Sept 24, 2022                                         Time:   0940 – 1000

After this session, the participants should be able to:

  1. Discuss the results of the recently published stroke trials.
  2. Describe the direction of the new and ongoing stroke trials.
  3. Predict the future direction of stroke research and management.

Ronit Agid – Women in Interventional Neuroradiology

Date:   Sat, Sept 24, 2022                                         Time:   1030 – 1100

After this session, the participants should be able to:

  1. Acquire an understanding of the status of women INR physicians.
  2. Describe the similarities and differences among women and men practicing INR.
  3. Propose possible ways to include more women in the INR profession.

Ruba Kiwan and Ravinder-Jeet Singh – Building a Stroke Service from 0 to 24 -7

Date:   Sat, Sept 24, 2022                                         Time:   1100 – 1130

After this session, the participants should be able to:

  1. Describe the development of the EVT service in the Northeast Ontario- from conception to operations.
  2. Discuss the opportunities and hurdles while developing 24/7 EVT service.
  3. Identify the current EVT Access Pathways in the Northeast Ontario.
  4. Review the HSN EVT performance and patient outcomes in the first 2 years.

Transitioning from being a fellow to being Staff:  Lessons learned

Will Guest – Vancouver, Jesse Klostranec – Montreal, Emanuele Orru – Boston, Ayman Qureshi – London, Patrick Nicholson – Toronto

Date:   Sat, Sept 24, 2022                                         Time:   1130 – 1200

After this session, the participants should be able to:

  1. Describe potential problems and challenges in the career transition from fellow to staff – “What I wish I’d known before becoming staff”.
  2. Discuss potential strategies to maximize success in first few years of career and minimize potential burnout.

René Chapot – KTB LECTURESHIP – How to survive INR

Date:   Sat, Sept 24, 2022                                         Time:   1300 – 1330

After this session, the participants should be able to:

  1. Describe the problems and challenges of working in the INR field.
  2. Formulate strategies to succeed in an INR career and minimize potential burnout.

Decision Making in Acute Stroke: Tough Cases

Lissa Peeling – Saskatoon, Brian van Adel – Hamilton, Sachin Pandey – London, ON

Date:   Sat, Sept 24, 2022                                         Time:   1330 – 1500

After these sessions, the participants should be able to:

  1. Describe the challenges of decision making in acute stroke, its treatment and potential complications and failures.
  2. Examine the example cases and discuss treatment strategies for each case.

CONTACT INFORMATION

For questions, please contact
Sasikhan Geibprasert (cnrcourse@gmail.com) or Dr. Timo Krings (timo.krings@uhn.ca)