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ObjectiveTo evaluate sex differences in mortality among people with kidney failure compared with the general population.DesignPopulation based cohort study using data linkage.SettingThe Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), which includes all patients receiving kidney replacement therapy in Australia (1980-2019) and New Zealand (1988-2019). Data were linked to national death registers to determine deaths and their causes, with additional details obtained from ANZDATA.ParticipantsOf 82 844 people with kidney failure, 33 329 were female (40%) and 49 555 were male (60%); 49 376 deaths (20 099 in female patients; 29 277 in male patients) were recorded over a total of 536 602 person years of follow-up.Main outcome measuresRelative measures of survival, including standardised mortality ratios, relative survival, and years of life lost, using general population data to account for background mortality (adjusting for country, age, sex, and year). Estimates were stratified by dialysis modality (haemodialysis or peritoneal dialysis) and for the subpopulation of kidney transplant recipients.ResultsFew differences in outcomes were found between male and female patients with kidney failure. However, compared with the general population, female patients with kidney failure had greater excess all cause deaths than male patients (female patients: standardised mortality ratio 11.3, 95% confidence interval 11.2 to 11.5, expected deaths 1781, observed deaths 20 099; male patients: 6.9, 6.8 to 6.9, expected deaths 4272, observed deaths 29 277). The greatest difference was observed among younger patients and those who died from cardiovascular disease. Relative survival was also consistently lower in female patients, with adjusted excess mortality 11% higher (95% confidence interval 8% to 13%). Average years of life lost was 3.6 years (95% confidence interval 3.6 to 3.7) greater in female patients with kidney failure compared with male patients across all ages. No major differences were found in mortality by sex for haemodialysis or peritoneal dialysis. Kidney transplantation reduced but did not entirely remove the sex difference in excess mortality, with similar relative survival (P=0.83) and years of life lost difference reduced to 2.3 years (95% confidence interval 2.2 to 2.3) between female and male patients.ConclusionsCompared with the general population, female patients had greater excess deaths, worse relative survival, and more years of life lost than male patients, however kidney transplantation reduced these differences. Future research should investigate whether systematic differences exist in access to care and possible strategies to mitigate excess mortality among female patients.

Objective To estimate the changes in life expectancy and years of life lost in 2020 associated with the covid-19 pandemic. Design Time series analysis. Setting 37 upper-middle and high income countries or regions with reliable and complete mortality data. Participants Annual all cause mortality data from the Human Mortality Database for 2005-20, harmonised and disaggregated by age and sex. Main outcome measures Reduction in life expectancy was estimated as the difference between observed and expected life expectancy in 2020 using the Lee-Carter model. Excess years of life lost were estimated as the difference between the observed and expected years of life lost in 2020 using the World Health Organization standard life table. Results Reduction in life expectancy in men and women was observed in all the countries studied except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020. No evidence was found of a change in life expectancy in Denmark, Iceland, and South Korea. The highest reduction in life expectancy was observed in Russia (men: −2.33, 95% confidence interval −2.50 to −2.17; women: −2.14, −2.25 to −2.03), the United States (men: −2.27, −2.39 to −2.15; women: −1.61, −1.70 to −1.51), Bulgaria (men: −1.96, −2.11 to −1.81; women: −1.37, −1.74 to −1.01), Lithuania (men: −1.83, −2.07 to −1.59; women: −1.21, −1.36 to −1.05), Chile (men: −1.64, −1.97 to −1.32; women: −0.88, −1.28 to −0.50), and Spain (men: −1.35, −1.53 to −1.18; women: −1.13, −1.37 to −0.90). Years of life lost in 2020 were higher than expected in all countries except Taiwan, New Zealand, Norway, Iceland, Denmark, and South Korea. In the remaining 31 countries, more than 222 million years of life were lost in 2020, which is 28.1 million (95% confidence interval 26.8m to 29.5m) years of life lost more than expected (17.3 million (16.8m to 17.8m) in men and 10.8 million (10.4m to 11.3m) in women). The highest excess years of life lost per 100 000 population were observed in Bulgaria (men: 7260, 95% confidence interval 6820 to 7710; women: 3730, 2740 to 4730), Russia (men: 7020, 6550 to 7480; women: 4760, 4530 to 4990), Lithuania (men: 5430, 4750 to 6070; women: 2640, 2310 to 2980), the US (men: 4350, 4170 to 4530; women: 2430, 2320 to 2550), Poland (men: 3830, 3540 to 4120; women: 1830, 1630 to 2040), and Hungary (men: 2770, 2490 to 3040; women: 1920, 1590 to 2240). The excess years of life lost were relatively low in people younger than 65 years, except in Russia, Bulgaria, Lithuania, and the US where the excess years of life lost was >2000 per 100 000. Conclusion More than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women. Excess years of life lost associated with the covid-19 pandemic in 2020 were more than five times higher than those associated with the seasonal influenza epidemic in 2015.

ObjectiveTo compare differences in academic performance between adolescents who were randomised in infancy to modified or standard infant formula.DesignLinkage of seven dormant randomised controlled trials to national education data.SettingFive hospitals in England, 11 August 1993 to 29 October 2001, and schools in England, September 2002 to August 2016.Participants1763 adolescents (425 born preterm, 299 born at term and small for gestational age, 1039 born at term) who took part in one of seven randomised controlled trials of infant formula in infancy.InterventionsNutrient enriched versus standard term formula (two trials), long chain polyunsaturated fatty acid (LCPUFA) supplemented versus unsupplemented formula (two trials), high versus low iron follow-on formula (one trial), high versus low sn-2 palmitate formula (one trial), and nucleotide supplemented versus unsupplemented formula (one trial).Main outcome measuresThe primary outcome, determined by linkage of trial data to school data, was the mean difference in standard deviation scores for mandated examinations in mathematics at age 16 years. Secondary outcomes included differences in standard deviation scores in English (16 and 11 years) and mathematics (11 years). Analysis was by intention to treat with multiple imputation for participants missing the primary outcome.Results1607 (91.2%) participants were linked to school records. No benefit was found for performance in mathematics examinations at age 16 years for any modified formula: nutrient enriched in preterm infants after discharge from hospital, standard deviation score 0.02 (95% confidence interval −0.22 to 0.27), and nutrient enriched in small for gestational age term infants −0.11 (−0.33 to 0.12); LCPUFA supplemented in preterm infants −0.19 (−0.46 to 0.08) and in term infants −0.14 (−0.36 to 0.08); iron follow-on formula in term infants −0.12 (−0.31 to 0.07); and sn-2 palmitate supplemented formula in term infants −0.09 (−0.37 to 0.19). Participants from the nucleotide trial were too young to have sat their General Certificate of Secondary Education (GCSE) examinations at the time of linkage to school data. Secondary outcomes did not differ for nutrient enriched, high iron, sn-2 palmitate, or nucleotide supplemented formulas, but at 11 years, preterm and term participants randomised to LCPUFA supplemented formula scored lower in English and mathematics.ConclusionsEvidence from these randomised controlled trials indicated that the infant formula modifications did not promote long term cognitive benefit compared with standard infant formulas.

ObjectiveTo systematically review the conduct and reporting of formula trials.DesignSystematic review.Data sourcesMedline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1 January 2006 to 31 December 2020.Review methodsIntervention trials comparing at least two formula products in children less than three years of age were included, but not trials of human breast milk or fortifiers of breast milk. Data were extracted in duplicate and primary outcome data were synthesised for meta-analysis with a random effects model weighted by the inverse variance method. Risk of bias was evaluated with Cochrane risk of bias version 2.0, and risk of undermining breastfeeding was evaluated according to published consensus guidance. Primary outcomes of the trials included in the systematic review were identified from clinical trial registries, protocols, or trial publications.Results22 201 titles were screened and 307 trials were identified that were published between 2006 and 2020, of which 73 (24%) trials in 13 197 children were prospectively registered. Another 111 unpublished but registered trials in 17 411 children were identified. Detailed analysis was undertaken for 125 trials (23 757 children) published since 2015. Seventeen (14%) of these recently published trials were conducted independently of formula companies, 26 (21%) were prospectively registered with a clear aim and primary outcome, and authors or sponsors shared prospective protocols for 11 (9%) trials. Risk of bias was low in five (4%) and high in 100 (80%) recently published trials, mainly because of inappropriate exclusions from analysis and selective reporting. For 68 recently published superiority trials, a pooled standardised mean difference of 0.51 (range −0.43 to 3.29) was calculated with an asymmetrical funnel plot (Egger’s test PConclusionsThe results show that formula trials lack independence or transparency, and published outcomes are biased by selective reporting.Systematic review registrationPROSPERO 2018 CRD42018091928.

ObjectiveTo update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups.DesignSystematic review and individual participant data meta-analysis.Data sourcesMedline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018.Review methodsEligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics.ResultsData from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older.ConclusionsResearchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool atwww.depressionscreening100.com/phq.Study registrationPROSPERO CRD42014010673.

Objective To estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death). Design Test negative design study. Setting Ontario, Canada between 14 December 2020 and 19 April 2021. Participants 324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2. Interventions BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. Main outcome measures Laboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes. Results Of 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation. Conclusions Two doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.

Alexandra Chung and colleagues call for governments to prioritise child obesity as they implement measures to recover from the pandemic

IntroductionAlthough most of the stroke centers reported a remarkable decline in stroke care during the coronavirus disease 2019 (COVID-19) pandemic, data from Central Europe are limited.ObjectivesWe aimed to assess the impact of the ongoing pandemic on the Hungarian ischemic stroke (IS) care system.MethodsAt a national level, we retrospectively accessed the number of IS admissions and reperfusion therapies, i.e., intravenous thrombolysis (IVT) and endovascular therapy (EVT), from 2 January 2017 to 31 December 2020 in Hungary. We used different statistics (means, medians, trends, relative rates, linear relationships) to analyze the impact of the COVID-19 outbreak on the number of IS admissions and reperfusion therapies.ResultsAlthough the non-standardized number of IS admissions, IVTs and EVTs decreased only in some measure during the COVID-19 epidemic, the trend analysis demonstrated a significant disruption in the trends. The reduction’s dynamic and extent have differed for each variable, and the number of IS admissions decreased to a disproportionally larger extent than the number of IVTs and EVTs. In contrast to IVT, the number of IS admissions and EVTs showed a significant negative linear correlation with the number of new or cumulative COVID-19 cases in Hungary.ConclusionsCollateral damages of the COVID-19 outbreak on the Hungarian IS care system were demonstrated. The disproportionally greater decline of IS admission numbers could partially be explained by the effect of health emergency operative measures. Further studies are needed to evaluate the causes of our observations.ReferencesBersano A, Kraemer M, Touze E, Weber R, Alamowitch S, Sibon I, et al. Stroke care during the COVID-19 pandemic: experience from three large European countries. Eur J Neurol 2020;27(9):1794–800. https://doi.org/10.1111/ene.14375Bojti PP, Stang R, Gunda B, Sipos I, Bereczki D. A jarulekos egeszsegugyi vesztesegek retrospektiv, egycentrumos felmerese. [Effects of COVID-19 pandemic on acute ischemic stroke care. A single-centre retrospective analysis of medical collateral damage]. Orv Hetil 2020;161(34):1395–9. https://doi.org/10.1556/650.2020.31936. Hungarian.Slowik A, Nowak R, Popiela T. Significant fall in stroke admissions in the Malopolska Voivodeship of Poland during the COVID-19 pandemic. Neurol Neurochir Pol 2020;54(5):471–2. https://doi.org/10.5603/PJNNS.a2020.0056DisclosureNothing to disclose

Introduction Various mechanical thrombectomy devices and techniques including Stentrievers and Aspiration Catheters are used in the treatment of acute ischemic stroke.1Balloon Guide Catheters (BGC) are commonly used to achieve flow control. A new generation of ‘Super-bore’ 088’’ catheters are currently being tested clinically.2 3 Objective/Aim We evaluated the in-vitro revascularization performance of current and novel thrombectomy approaches. Methods National University of Ireland Galway Research Ethics Committee approved the study. Clot analogues from human blood were used to create ICA (20 mm) and MCA (10 mm) occlusions in an In-vitro thrombectomy model. Thrombectomy setups tested were; ADAPT: Millipede 088, SOFIA, SOFIA+BGC and Combination; Millipede 088+Solitaire, SOFIA+BGC+Solitaire, SOFIA+Solitaire. 10 replicates of each test were performed. Endpoints were First Pass Effect (FPE), Second and Third-pass success and procedural-related distal emboli from 50–1000µm. Results The Millipede 088 catheter achieved the highest rate of FPE in both ICA (60%) and MCA (100%) occlusions and had the lowest number of procedural-related emboli compared to all other device setups, followed by the Millipede 088+Solitaire technique. Of the currently used techniques, the use of a Solitaire in combination with a SOFIA lead to a higher rate of FPE in ICA occlusions (40% vs 20%, SOFIA+BGC+Solitaire vs SOFIA+BGC), but a lower rate of FPE in MCA occlusions (50% vs 60%, SOFIA+BGC+Solitaire vs SOFIA+BGC). Conclusions The novel 0.088’’ aspiration catheter achieves the best FPE rates in both ICA and MCA occlusions. In terms of existing techniques, ADAPT is more effective in the MCA, while the stentrievers provide a benefit in the ICA. References Hafeez MU, Kan P, Srivatsan A, Moore S, Jafari M, DeLaGarza C, et al. Comparison of first-pass efficacy among four mechanical thrombectomy techniques: a single-center experience. World Neurosurgery 2020;144:e533–e40. Gershon BS, Bageac DV, Shigematsu T, Majidi S, De Leacy R. Republished: first clinical report of aspiration through a novel 0.088-inch catheter positioned in the M1 middle cerebral artery for ELVO thrombectomy. Journal of NeuroInterventional Surgery 2021;13(4):e4–e. Nogueira RG, Mohammaden MH, Al-Bayati AR, Frankel MR, Haussen DC. Preliminary experience with 088 large bore intracranial catheters during stroke thrombectomy. Interventional Neuroradiology 2020:1591019920982219. Disclosure Sean Fitzgerald received research funding from Enterprise Ireland that is co-funded by Perfuze Ltd. Liam Mullins declares the following competing interest; Perfuze (stock options). John Thornton declares the following competing interests; Perfuze (Physician Advisory Board, stock options); Consultancy fees: Microvention, Johnson and Johnsons. Raul G. Nogueira declares the following competing interests: consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Imperative Care, Medtronic, Phenox, Prolong Pharmaceuticals, Stryker Neurovascular and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, and Perfuze.

IntroductionCerebral vasospasms are an important cause of considerable morbidity and mortality after subarachnoid hemorrhage (SAH). In addition to conservative therapy, endovascular spasmolysis can play an important role in the management of this disease. Still, optimal management remains controversial. Stent-retrievers may provide an alternative and additional technique for the treatment of cerebral vasospasms.1Aim of StudyTo investigate the feasibility and safety of mechanical spasmolysis with different stent-retrievers.MethodsWe retrospectively analyzed all patients with vasospasms after SAH that were treated with percutaneous spasmolysis using self-expanding and adjustable stent-retrievers and remodeling devices in addition to conventional vasospasm therapy.Results21 vessel-segments with vasospasms in 12 patients were included. Spasmolysis with stent-retrievers was conducted in proximal and distal vessel segments without complications. In 42.9% a good effect, in 52.4% a medium effect and in only one case (4.8%) a poor angiographic effect was achieved, respectively. Spasmolysis was more effective in distal vessel segments compared to proximal (reduction of stenosis 56.6% vs. 26.7%, p

Introduction Emerging data show an association between increased mechanical thrombectomy (MT) passes and poor outcomes in ischemic stroke. Clots that require ≥3 passes are more often tough, fibrin-rich thrombi than those retrieved within two passes. Aims To assess the clinical and economic burden of number of MT passes, we evaluated the odds of achieving successful reperfusion and functional independence in first pass, or 2–3 passes, compared to ≥4 passes. Methods A retrospective observational study was conducted on 857 cases treated with MT from the Irish National Thrombectomy database. Outcomes were 90-day functional independence (mRS 0–2) and successful reperfusion (mTICI 2b-3) stratified by number of passes (1; 2–3; and ≥4) with multivariable regression to adjust for confounding variables. A decision-tree economic model was informed by 90-day mRS: independent (0–2), dependent (3–5), or dead, with literature-derived annual healthcare costs by mRS. Results The odds of achieving successful reperfusion were significantly higher for 1 vs. ≥4 passes (OR 7.19, p Conclusion Odds of achieving good outcomes decline with MT passes, while care costs increase. Thrombectomy devices that improve interaction with tough clots for rapid and complete retrieval in fewer passes may improve clinical and economic outcomes. References Yoo AJ. Journal of Stroke 2017;19(2):121. Douglas A. JNIS 2020;12(6):557–562. Liebeskind DS. Stroke 2011;42(5):1237–1243. Abbasi M. Interventional Neuroradiology 2021;202115910199211009119. Siddiqui AH. Stroke 2021;52(Suppl_1):AP14–AP14. Garcia-Tornel A. Stroke 2019;50(7):1781–1788. Shireman TI. Stroke 2017;48(2):379–387. Disclosure Dr. Jack Alderson, Radiology, Beaumont Hospital. Prof. Dr. John Thornton, Neuroradiology, Beaumont Hospital. Consultancy for Johnson & Johnson, Perfuze and Microvention. Shareholder Perfuze. Cindy Tong and Shelly Ikeme are employees of Johnson & Johnson. Heather Cameron is an employee of EVERSANA, a consultant for Johnson & Johnson. This research is funded by Cerenovus – a company of Johnson & Johnson

Introduction Tectal arteriovenous malformations (TAVMs) are rare lesions deeply located close to eloquent structures making them challenging to treat. Aim of Study To present clinical revealing conditions, angiographic features and treatment strategies of TAVMs through a single center retrospective case series. Methods TAVMs were defined as a nidus located in the parenchyma or on the pia mater of the posterior midbrain. Records of consecutive patients admitted with TAVMs over a 21-years‘ period were retrospectively analyzed. Results Thirteen patients (1.63% of the complete cohort; 10 males), mean age 48 years, were included. All patients presented with intracranial hemorrhage. Two patients (15%) died after an early recurrent bleeding. Mean size of the TAVMs was 10.1±5 mm. Multiple arterial feeders was noted in every cases. Eleven patients underwent an exclusion treatment; 8 via embolization (6 via arterial access and 2 via venous access) and 4 via stereotactic radiosurgery (SRS) (1 patient received both). Overall success treatment rate was 7/11 patients (64% overall; 63% in the embolization group, 25% in the SRS group). Two hemorrhagic events lead to a worsened outcome, one during embolization and one several years after SRS. All other patients remained clinically stable or improved. Conclusion TAVMs are rare but stereotypic lesions found in a hemorrhagic context. Multiple arterial feeders are always present. Endovascular therapy seems to be an effective technic with relatively low morbidity; SRS had a low success rate but was only use in a limited number of patients. References Chaynes P. Microsurgical anatomy of the venous drainage of the mesencephalodiencephalic junction. Neurosurgery 2004;54:678–85; discussion 685–686. Thines L, et al. Challenges in the management of ruptured and unruptured brainstem arteriovenous malformations: outcome after conservative, single-modality, or multimodality treatments. Neurosurgery 2012;70:155–61; discussion 161. Cohen-Inbar O, et al. Stereotactic radiosurgery for brainstem arteriovenous malformations: a multicenter study. Neurosurgery 2017;81:910–20. Madhugiri VS, et al. Brainstem arteriovenous malformations: lesion characteristics and treatment outcomes. J Neurosurg 2018;128:126–36. Han SJ, et al. Brainstem arteriovenous malformations: anatomical subtypes, assessment of ‘occlusion in situ’ technique, and microsurgical results. J Neurosurg 2015;122:107–17. Disclosure Nothing to disclose

Introduction The severity of early brain edema after aneurysm rupture was reported to be strongly associated with the risk of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Objective/Aim Using the recently developed SEBES, we analyzed the predictors of early brain edema and its impact on the complications related to intracranial pressure (ICP) increase after SAH. Methods All consecutive SAH cases treated between January 2003 and June 2016 with assessable SEBES were included (n=745). Data on demographic characteristics, previous medical history, initial severity of SAH, need for conservative ICP treatment and decompressive craniectomy, occurrence of cerebral infarcts and unfavorable outcome at 6 months (mRS>2) were collected. Univariable and multivariable analyses were performed. Results Younger age ( Conclusions The SEBES is a reliable predictor of ICP-related complications and poor outcome of SAH. Along with age- and sex-related predisposition to early brain edema, presence of certain comorbidities like hypothyroidism and renal diseases seem to play a protective role in the severity of early brain edema after SAH. References Ahn SH, Savarraj JP, Pervez M, Jones W, Park J, Jeon SB, et al. The subarachnoid hemorrhage early brain edema score predicts delayed cerebral ischemia and clinical outcomes. Neurosurgery 2018;83(1):137–45. Rass V, Helbok R. Early brain injury after poor-grade subarachnoid hemorrhage. Curr Neurol Neurosci Rep 2019;19(10):78. Eibach M, Won SY, Bruder M, Keil F, Herrmann E, Berkefeld J, et al. Age dependency and modification of the subarachnoid hemorrhage early brain edema score. J Neurosurg 2020:1–7. Disclosure Nothing to disclose

6 cases of neurovascular treatment with remote assistance are presented. various techniques (zoom, smart glasses and hospital internal system) 2 aneurysm treatments with flow diversion are presented. 1 case with web device. and 3 cases of stroke. All cases occurred during the covid 19 pandemic. Multiple tests were carried out during the simulation courses. Evaluating communication in real time. mastery of the images and mastery of the software. Reference Bechstein M, et al. Interhospital teleproctoring of endovascular intracranial aneurysm treatment using a dedicated live-streaming technology: first experiences during the COVID-19 pandemic. BMJ Case Rep 2020. PMID: 33012707. Disclosure Boris Pabon: proctorship con MEDTRONIC, Microvention Consultant MIVI