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Introduction: Several studies have addressed technical aspects of endovascular thrombectomy (EVT), but it is not well known how procedural factors contribute to technical success in routine healthcare. The aim was to explore factors associated with technically successful EVT on nationwide scale., Methods: We did an observational register-based study assessing factors associated with technical success off anterior circulation EVT in Sweden. The main outcome was successful recanalization defined as modified treatment in cerebral ischemia score 2b-3. The association between baseline and treatment variables and successful recanalization were explored using Chi-square(d) test and univariable logistic regression. Multivariable logistic regression was used to define predictors of successful recanalization., Results: The study included 3211 patients treated during 2015 to 2020. Successful recanalization was achieved in 83.1% (2667) with a gradual improvement in technical outcome over the period. After adjustment for age and occlusion location, thet use of general anesthesia, balloon guide catheter (BGC) and an operator with an overall success rate of >85% were independent predictors of successful recanalization. An overall operator success rate of <80% or 80-85%, and an annual center volume lower than 50 were predicitors of recanalization failure., Conclusion: This study illustrates factors associated with procedural success in endovascular thrombectomy on a nationwide scale including the use of general anesthesia, BGC, annual center volumes >50 cases per year and the overall success rate of the individual operator. It highlights the potential benefit of systematic performance measurements, benchmarking, and continuous training to bring all centers and operators to the highest level of performance., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JW is a founder and shareholder of Uman Sense AB and has received speaker honoraria from Siemens Healthineers, BALT group and Medtronic Inc. TA is a consultant for Anaconda, Cerenovus, Optimize Neurovascular and Rapid Medical, and a shareholder in Ceroflo. TU received honoraria from ASTRA ZENECA for an expert group assignment, and speaker honoraria from Siemens Healthineers.

Background: Perforator aneurysms of the basilar artery (PABA) are rare causes of subarachnoid haemorrhage (SAH) and challenging to diagnose. We present two cases of SAH caused by PABA diagnosed by cone beam computed tomography angiography (CBCTA) and a novel non-invasive method - 7T magnetic resonance imaging (7T MRI)., Methods: Two patients with SAH, diagnosed with PABA, were imaged on day 9 and 13 after onset, respectively, with CBCTA and 7T MR angiography (MRA) performed on the day after and at follow-up at 3 months., Results: All four 7T MRI examinations in the two patients were technically successful with fully diagnostic images. No endovascular treatment was performed and control with 7T MRA at 3 months showed no remaining aneurysms., Conclusion: PABA can be imaged with 7T MRI - a novel non-invasive method, allowing non-invasive follow-up to monitor this rare cause of SAH.

The treatment of choice of vein of Galen aneurysmal malformation (VGAM) involves endovascular procedures that can be difficult to perform in high-flow fistulas. We describe the use of rapid ventricular pacing (RVP), a well-known cardiologic technique, to safely treat a high-flow fistula in an infant with VGAM.