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Background: The first-pass effect in endovascular thrombectomy (EVT) has been associated with better clinical outcomes and decreased stroke progression in large vessel occlusion but has not been evaluated in distal, medium vessel occlusions (DMVOs)., Objective: To assess the impact on clinical outcome and stroke progression of the modified first-pass effect (defined as a successful first-pass [modified Thrombolysis In Cerebral Infarction 2b/2c/3] revascularization) in patients who underwent EVT for a primary DMVOs., Methods: We collected data from consecutive patients who underwent EVT for a primary DMVO at a single large academic center. We compared the rate of good clinical outcome (modified Rankin Scale of 0-2 at 3 months) and stroke progression between patients who demonstrated modified first-pass effect (mFPE) vs those who did not (no-mFPE)., Results: Between January 2018 and January 2021, we included 60 patients who underwent EVT for an acute ischemic stroke with a primary DMVO. Overall, mFPE was achieved in 32% (19/60) of EVTs. The mFPE was associated with a higher rate of good clinical outcome compared with no-mFPE (89% vs 46%, odds ratio = 16.04 [2.23-115.39], P = .006 in multivariate analysis). Final stroke volume was less among mFPE patients (6.9 mL [4.7-13.6] vs 23 mL [14.6-47], P = .001) as was stroke progression (6.8 mL [4-12.1] vs 17.8 mL [8.1-34.9], P = .016). The mFPE was still associated with higher rates of good clinical outcome when compared with patients reaching an modified Thrombolysis In Cerebral Infarction score ≥2b in more than 1 pass (89% vs 53%; odds ratio = 7.37 [1.43-38.08], P = .017)., Conclusion: The mFPE may be associated with better clinical outcomes and lower stroke progression in DMVO., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Purpose: Wide-neck bifurcation aneurysms remain challenging for the neurointerventionist and/or neurosurgeon despite many recent advances. The pCONus (Phenox, Bochum, Germany) is an emerging device for endovascular neck protection, we report the first long-term results of this device., Methods: We performed a retrospective analysis of all consecutive intracranial wide-neck bifurcation aneurysms treated with the pCONus. Patients' characteristics were reviewed, procedural complications, angiographic (Roy-Raymond scale) and clinical outcomes were documented., Results: Between January 2016 and September 2019, 43 patients (74% female, median age 56 [49-66] years) with 43 wide-neck bifurcation aneurysms (mean width of 6.8 ± 2.1 mm, dome/neck ratio of 1.3 ± 0.2 and neck of 5.2 ± 1.3 mm) were included. A procedural angiographic complication was reported in five patients (12%), no patient presented a post-operative neurological deficit or long-term complication, mortality rate was 0%. At last follow-up (median of 46.5 months [38.3-51.7]), an adequate occlusion (complete and neck remnant) was observed in 37/43 patients (86%) and an aneurysm remnant in 6/43 (14%). Four patients (9%) needed retreatment. No in-stent stenosis or branch occlusion was depicted., Conclusion: pCONus device provides a safe and efficient alternative for endovascular wide-neck bifurcation aneurysms management, with long-term stability.

Purpose: To evaluate the safety and efficacy of the Tigertriever 13 (Rapid Medical, Yoqneam, Israel) stent retriever in acute ischemic stroke (AIS) patients with primary or secondary distal, medium vessel occlusions (DMVO)., Methods: We performed a retrospective analysis of all consecutive AIS patients who underwent thrombectomy with the Tigertriever13 for DMVO. Patients' characteristics were reviewed, procedural complications, angiographic (modified thrombolysis in cerebral infarction score [mTICI]) and clinical (modified Rankin Scale [mRS]) outcomes were documented., Results: Between November 2019 and November 2020, 16 patients with 17 DMVO were included (40% female, median age 60 [50-65] years). The Tigertriever13 was used in 11/17 (65%, median NIHSS of 8 [6-15]) primary DMVO and in 6/17 (35%, median NIHSS of 20 [13-24]) cases of secondary DMVO after a proximal thrombectomy. The successful reperfusion rate (mTICI 2b, 2c, 3) was 94% (16/17) for the dedicated vessel. At day 1, CT imaging showed a subarachnoid hemorrhage in 29% of the cases and a parenchymal hematoma in 12%. At 3 months, 65% of the patients (11/17) had a favorable outcome (mRS 0-2)., Conclusion: Mechanical thrombectomy using the Tigertriever13 appears to be safe and effective for DMVO. Clinical and anatomical results are in line with those of patients with proximal occlusions.