21st Annual

Interventional Neuroradiology Symposium

& 6th Annual Karel G. Terbrugge Lectureship & Neurovascular Anatomy Workshop

***NEW DATES*** - September 17-19, 2021 – BMO Education & Conference Centre, Toronto, CA

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 – Posterior fossa Neurovascular Anatomy

 

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

  1. Recognize the normal and abnormal angioarchitecture of the posterior fossa and cranial nerves within this region.
  2. Apply the above knowledge to formulate the differential diagnoses and describe the pathophysiology and select the treatment options for various posterior fossa neurovascular diseases, including brain AVMs, dural AV fistulae, stroke, aneurysms and vertebra-basilar dissections.

 

Karel terBrugge – Vertebrobasilar Junction Arterial Anatomy and Development

Date:   17-Sep-21                                          Time:   8:00-8:30

After this session, the participants should be able to:

  1. Describe the embryology and maturation of the regional posterior circulation vasculature at the level of the vertebra-basilar junction
  2. Recognize normal as well as variations of the normal intracranial vasculature at the level of the vertebra-basilar junction

 

Waleed Brinjikji – PICA, AICA, SCA and basilar perforators – Anastomoses, Variations and Supply

Date:   17-Sep-21                                          Time:   8:30-9:00

After this session, the participants should be able to:

  1. Recognize the major territories of the PICA, AICA, SCA and basilar perforators.
  2. Describe the important variations and anastomoses of the PICA, AICA, SCA and basilar perforators and how it can impact the clinical presentation, imaging findings and treatment of neurovascular diseases.

 

Hiro Kiyosue – Posterior Fossa Dural Arteries

Date:   17-Sep-21                                          Time:   9:00-9:30

After this session, the participants should be able to:

  1. Name the major dural supply to the posterior fossa and where they originate from.
  2. Describe the roles that dural arteries have in different neurovascular diseases.

 

Will Guest – Posterior Fossa Venous System

Date:   17-Sep-21                                          Time:   9:30-10:00

After this session, the participants should be able to:

  1. Recognize the major veins and their drainage territories in the posterior fossa.
  2. Describe common variations of the venous system and their imaging findings.
  3. Identify abnormal venous architecture in relation to neurovascular diseases.

 

 

Timo Krings – CASE DISCUSSIONS Posterior fossa AVMs

Date:   17-Sep-21                                          Time:   10:30-11:00

After this session, the participants should be able to:

  1. Identify the neurovascular anatomy relevant for safe endovascular treatment of posterior fossa brain AVMs.
  2. Review the current methods to treat posterior fossa brain AVMs.
  3. Identify potential complications in endovascular posterior fossa brain AVM treatment.

 

Hiro Kiyosue – CASE DISCUSSIONS Posterior fossa dAVF

Date:   17-Sep-21                                          Time:   11:00-11:30

After this session, the participants should be able to:

  1. Recognize the common locations for dAVFs of the posterior fossa and their potential supply and drainage.
  2. Identify the presence of leptomeningeal or spinal drainage in posterior fossa dAVFs.
  3. Discuss the best treatment options for posterior fossa dAVFs depending on location, arterial supply and venous drainage.

 

Anderson Tsang – CASE DISCUSSIONS ICAD in the vertebrobasilar system

Date:   17-Sep-21                                          Time:   11:30-12:00

After this session, the participants should be able to:

  1. Analyze unique therapeutic considerations for ICAD
  2. Recognize the different presentations of ICAD

 

Waleed Brinjikji – PCA and its perforators

Date:   17-Sep-21                                          Time:   13:00-13:30

After this session, the participants should be able to:

  1. Identify the territory of the PCA and its branches.
  2. Recognize the major perforators of the PCA.

 

Vitor Pereira – EC-IC Anastomoses of the posterior fossa

Date:   17-Sep-21                                          Time:   13:30-14:00

After this session, the participants should be able to:

  1. Recognize the major extracranial-intracranial anastomoses in the posterior fossa and the role it has in various neurovascular diseases.
  2. Discuss the danger of endovascular treatment within the posterior fossa due to the anastomoses.

 

Maksim Shapiro – Arterial Supply of the CN VII-XII

Date:   17-Sep-21                                          Time:   14:00-14:30

After this session, the participants should be able to:

  1. Recognize the spectrum of variability that defines vascular supply to cranial nerves.
  2. Demonstrate the role of advanced / flat panel imaging in helping identify cranial nerve supply.
  3. Review diagnostic and interventional techniques aimed at minimizing cranial nerve risk.

 

Timo Krings – Overview on Dissecting Arterial Diseases

Date:   17-Sep-21                                          Time:   14:30-15:00

After this session, the participants should be able to:

  1. Recognize the clinical importance of arterial dissecting diseases.
  2. Review the current endovascular and medical approaches to arterial dissections.
  3. Report salient imaging features of arterial dissections.

 

Patrick Nicholson – CASE DISCUSSIONS Dissecting vertebral artery aneurysms

Date:   17-Sep-21                                          Time:   15:30-16:00

After this session, the participants should be able to:

  1. Recognize imaging characteristics of dissecting vertebral artery aneurysms.
  2. Discuss overall treatment strategies (microsurgical/deconstructive/reconstructive approaches) and the evidence for each.
  3. Examine the representative cases and discuss technical nuances.

 

Timo Krings – CASE DISCUSSIONS Midbasilar aneurysms – Types

Date:   17-Sep-21                                          Time:   16:00-16:30

After this session, the participants should be able to:

  1. Assess the different types of midbasilar artery aneurysm.
  2. Review endovascular and surgical management strategies of midbasilar artery aneurysms.
  3. Report salient imaging features of midbasilar artery aneurysms.

 

Vitor Pereira – CASE DISCUSSIONS Dissecting posterior cerebral artery aneurysms – Management

Date:   17-Sep-21                                          Time:   16:30-17:00

After this session, the participants should be able to:

  1. Assess the different types and presentations of dissecting PCA aneurysms.
  2. Examine the representative cases and discuss the treatment strategies for dissecting PCA aneurysms.

 

Day 2 – INR Symposium

 

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

  1. Determine when advanced neuroimaging techniques, such as 3D DSA, fMRI or vessel wall imaging, are necessary for evaluation of certain types of neurovascular diseases.
  2. Compare the benefits of new neurovascular imaging techniques and devices, such as AI, use of Robotics, flow diversion and Web devices, versus the current standard imaging/treatment options.
  3. Describe when a patient would likely benefit from spinal augmentation and what type is indicated.
  4. Discuss the current controversies in aneurysm treatment, particularly in pediatric aneurysms and recurrent aneurysm treatment strategies.

 

 

Azam Syed Ahmed – Time resolved 3D DSA – Technique and Applications

Date:   18-Sep-21                                          Time:   8:00-8:20

After this session, the participants should be able to:

  1. Describe what time resolved 3D DSA is and how it differs from standard DSA techniques.
  2. Discuss the application of time resolved 3D DSA in interventional neuroradiology.

 

Teshima / Vitor Pereira – Surgical & combined approaches to facial vascular malformations

Date:   18-Sep-21                                          Time:   8:20-8:40

After this session, the participants should be able to:

  1. Discuss the risks and benefits of surgical versus endovascular treatment for facial vascular malformations.
  2. Summarize when to use surgery or combined treatment for facial vascular malformations.
  3. Discuss and formulate treatment plans for the example cases.

 

Jared Knopman – CSDH – an endovascularily treatable entity?

Date:   18-Sep-21                                          Time:   8:40-9:00

After this session, the participants should be able to:

  1. Recognize when endovascular treatment would be beneficial for CSDH.
  2. Review the current literature regarding endovascular treatment for CSDH.

 

Alexandre Boutet – Neuroimaging Advancements for Targeting in Functional Neurosurgery.

Date:   18-Sep-21                                          Time:   9:00-9:20

After this session, the participants should be able to:

  1. Describe the types of neuroimaging enabling “individualized” surgical targeting.
  2. Discuss the potential role of functional magnetic resonance imaging (fMRI) in improving postoperative care of patients with deep brain stimulation (DBS).

 

Ameer Hassan – AI in Stroke

Date:   18-Sep-21                                          Time:   9:20-9:40

After this session, the participants should be able to:

  1. Describe how AI improves Stroke triage.
  2. Discuss how AI improves the Door to Device Times.
  3. Summarize how AI can help improve stroke team communication.

 

Vitor Pereira – Robotics in INR

Date:   18-Sep-21                                          Time:   9:40-10:00

After this session, the participants should be able to:

  1. Describe how robotics is used in INR and the medical field.
  2. Discuss the risks and benefits of using robotics versus in person for interventional neuroradiology.

 

David Hasan – Current Status of Vessel Wall Imaging

Date:   18-Sep-21                                          Time:   10:30-11:00

After this session, the participants should be able to:

  1. Describe the application of high-resolution vessel wall imaging (HR-VWI) in neurovascular diseases.
  2. Review the latest research studies on HR-VWI.

 

Joanna Schaafsma – The Vessel Wall in Stroke and TIA

Date:   18-Sep-21                                          Time:   11:00-11:20

After this session, the participants should be able to:

  1. Differentiate the patterns of different intracranial arteriopathies on MR vessel wall imaging.
  2. Determine when intracranial MR vessel wall imaging has added value to the standard stroke work-up.
  3. Describe the potential use of MR carotid wall imaging for stroke prevention.

 

Daniel Mandell – The Vessel Wall in Aneurysms

Date:   18-Sep-21                                          Time:   11:20-11:40

After this session, the participants should be able to:

  1. Describe the potential indications for vessel wall MRI in patients with intracranial aneurysms.
  2. Review the current evidence for vessel wall MRI in the context of intracranial aneurysms.

 

Timo Krings – The Vessel Wall in AVMs

Date:   17-Sep-21                                          Time:   11:40-12:00

After this session, the participants should be able to:

  1. Report why it is important to understand the vessel wall in patients with brain AVM.
  2. Review current imaging strategies to visualize vessel wall pathology in AVMs.
  3. Identify features that pose an AVM at risk for subsequent rupture.

 

Waleed Brinjikji – O’Kelly / Dabus – Debate: Wide-neck Bifurcation Aneurysms: Web vs Stent/Coil …?

Date:   18-Sep-21                                          Time:   13:00-13:30

After this session, the participants should be able to:

  1. Describe the indications for the use of the WEB device.
  2. Review the literature and potential advantages of WEB compared to stenting/coiling for aneurysms.
  3. Identify the potential concerns with WEB / intrasaccular flow disruptors and discuss its implications for ruptured aneurysms.

 

Waleed Brinjikji – Derakshani / Radovanovic – Debate: Flowdiversion of Bifurcations

Date:   18-Sep-21                                          Time:   13:30-14:00

After this session, the participants should be able to:

  1. Describe the indications for flow diversion of bifurcation aneurysms.
  2. Discuss the risks and benefits of flow diversion versus surgical treatment for bifurcation aneurysms.
  3. Examine the example cases and discuss potential treatment options.

 

Jai Jai Shankar – Joshua Hirsch – Debate: Spinal Augmentation: Panacea or Placebo?

Date:   18-Sep-21                                          Time:   14:00-14:30

After this session, the participants should be able to:

  1. Describe the impact on morbidity/mortality of vertebral compression fracture (VCF) treatments.
  2. Review trial data associated with spinal augmentation.
  3. Evaluate the future directions of instrumented augmentation

 

Jai Jai Shankar – Roger Smith / Kieran Murphy – Debate: Spinal Augmentation: Kyphoplasty or Vertebroplasty?

Date:   18-Sep-21                                          Time:   14:30-15:00

After this session, the participants should be able to:

  1. Identify the difference between kyphoplasty and vertebroplasty and state their indications.
  2. Examine the example cases and discuss the treatment options.

 

Guilherme Dabus – CASES: Pushing the boundaries of Flowdiversion: Distal vessels, Ruptured Aneurysms…

Date:   18-Sep-21                                          Time:   15:25-15:50

After this session, the participants should be able to:

  1. Describe the indications of flow diversion in the distal vessels and in ruptured aneurysms.
  2. Discuss the risks and benefits of flow diversion in the distal vessels and in ruptured aneurysms versus other treatment options.

 

Waleed Brinjikji – CASES: Our experience with Web

Date:   18-Sep-21                                          Time:   15:50-16:15

After this session, the participants should be able to:

  1. Recognize the risks and benefits of using an intrasaccular flow disruptor device.
  2. Examine the example cases and discuss the treatment options.

 

Todd Abruzzo – CASES: Pediatric Aneurysms

Date:   18-Sep-21                                          Time:   16:15-16:50

After this session, the participants should be able to:

  1. Identify the different types of pediatric aneurysms.
  2. Describe how treatment of pediatric aneurysms differ from aneurysms in the adult population.
  3. Examine the example cases and discuss the treatment options.

 

Gary Redekop – CASES: Aneurysm Recurrences – Treatment strategies

Date:   18-Sep-21                                          Time:   16:50-17:15

After this session, the participants should be able to:

  1. Describe the incidence and nature of aneurysm recurrence after surgical and endovascular treatment.
  2. Identify the indications for treating recurrent aneurysms.
  3. Review the surgical and endovascular strategies and techniques to treat recurrent aneurysms.

 

 

Day 3 – INR Symposium

 

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

  1. Describe the current stroke treatment options and the direction of future stroke treatment.
  2. Discuss the current controversies in stroke treatment.
  3. Recognize how health policies apply to the field of interventional neuroradiology.

 

 

Joshua Hirsch – The Great Debate – what is the right training for stroke interventionalists?

Date:   19-Sep-21                                          Time:   8:00-8:20

After this session, the participants should be able to:

  1. Recognize the need for stroke interventionalists.
  2. Describe the current training pathways for stroke interventionalists.
  3. Discuss the potential solutions for a standardized training program across the different fields.

 

Ameer Hassan – The current role of Perfusion Imaging for Stroke Patient Selection

Date:   19-Sep-21                                          Time:   8:20-8:40

After this session, the participants should be able to:

  1. Describe the current uses of CT perfusion.
  2. Recognize why CT Perfusion is important in unknown onset patients.
  3. Discuss the next frontier for CT and MR perfusion imaging.

 

Anderson Tsang – Acute Stroke and underlying ICAD

Date:   19-Sep-21                                          Time:   8:40-9:00

After this session, the participants should be able to:

  1. Recognize the different presentations of stroke with underlying ICAD.
  2. Discuss the endovascular and open revascularization options in ICAD.

 

Michael Tymianski – Escape NA1 – the story so far

Date:   19-Sep-21                                          Time:   9:00-9:20

After this session, the participants should be able to:

  1. Summarize the history of neuroprotection for stroke.
  2. Describe the pharmacokinetic and pharmacodynamic properties of the investigational drug nerinetide (NA-1), a PSD-95 inhibitor in current Phase 3 trials for stroke.
  3. Recognize the impact of these PK-PD relationship on clinical trial design for nerinetide in stroke.

 

Matt Gounis – Adjunct Treatments in Acute Stroke – Hypothermia and beyond

Date:   19-Sep-21                                          Time:   9:20-9:40

After this session, the participants should be able to:

  1. Recognize the different types of adjunct treatments in acute stroke and how they work.
  2. Review the current literature and discuss the practical implications for adjunct treatments in acute stroke.

 

Andrew Demchuk – Stroke Management in 2030 – Where will we be

Date:   19-Sep-21                                          Time:   9:40-10:00

After this session, the participants should be able to:

  1. Review the current research and standard of care of stroke management.
  2. Predict the future direction of stroke research and stroke management.

 

van Adel – Agid / Marotta – Debate: Tandem Occlusions – What to open first?

Date:   19-Sep-21                                          Time:   10:30-11:00

After this session, the participants should be able to:

  1. Formulate a provisional plan for EVT cases with tandem occlusion.
  2. Discuss possible techniques to handle tandem occlusions and associated collateral anatomy.
  3. Recognize potential traps/complications and describe how to avoid them when managing tandem occlusions.

 

Pandey – Guest / Peterson – Debate: Radial or Femoral Approach to Acute Stroke

Date:   19-Sep-21                                          Time:   11:00-11:30

After this session, the participants should be able to:

  1. Summarize the role of radial access in acute stroke intervention and other neurointerventional procedures.
  2. Compare the risk and benefits of using the radial and femoral approaches for acute stroke interventions.
  3. Examine the example cases and discuss the selection between a radial and femoral approach for each case.

 

Todd Abruzzo – Debate : Pediatric Stroke – Who to treat? Who not to treat?

Date:   19-Sep-21                                          Time:   11:30-12:00

After this session, the participants should be able to:

  1. Recognize the causes and pathomechanisms of stroke in the pediatric population.
  2. Summarize the difference between pediatric and adult stroke and how it pertains to treatment options.
  3. Examine the example cases and discuss the risk and benefits of treatment in each case.

 

Joshua Hirsch – KTB LECTURESHIP – Health Policy Update – INR style

Date:   19-Sep-21                                          Time:   13:00-13:30

After this session, the participants should be able to:

  1. Summarize the evolution of fee for service to accountable care.
  2. Assess the state of affordable care in the United States.
  3. Describe what is meant by “cost” in interventional neuroradiology.

 

Decision Making in Acute Stroke: Tough Cases

Andrew Demchuk – Calgary, Daniel Roy – Montreal, Lissa Peeling – Saskatoon

Date:   19-Sep-21                                          Time:   13:30-15:00

After these sessions, the participants should be able to:

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

 

 

    CONTACT for any questions

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